Prevalence of Screening for Diabetes Mellitus in Patients Previously Diagnosed with Gestational Diabetes: Factors Related to its Performance

OBJECTIVE

 To determine how many patients underwent screening for diabetes mellitus (DM) in the puerperium after a diagnosis of gestational DM (GDM) and which factors were related to its performance.

METHODS

 The present is a prospective cohort study with 175 women with a diagnosis of GDM. Sociodemographic and clinico-obstetric data were collected through a questionnaire and a screening test for DM was requested six weeks postpartum. After ten weeks, the researchers contacted the patients by telephone with questions about the performance of the screening. The categorical variables were expressed as absolute and relative frequencies. The measure of association was the relative risk with a 95% confidence interval (95%CI), and values of p ≤ 0.05 were considered statistically significant and tested through logistic regression.

RESULTS

 The survey was completed by 159 patients, 32 (20.1%) of whom underwent puerperal screening. The mean age of the sample was of 30.7 years, and most patients were white (57.9%), married (56.6%), and had had 8 or more years of schooling (72.3%). About 22.6% of the patients used medications to treat GDM, 30.8% had other comorbidities, and 76.7% attended the postnatal appointment. Attendance at the postpartum appointment, the use of medication, and the presence of comorbidities showed an association with the performance of the oral glucose tolerance test in the puerperium.

CONCLUSION

 The prevalence of screening for DM six weeks postpartum is low in women previously diagnosed with GDM. Patients who attended the postpartum consultation, used medications to treat GDM, and had comorbidities were the most adherent to the puerperal screening. We need strategies to increase the rate of performance of this exam.

Legal Pregnancy Interruption due to Sexual Violence in a Public Hospital in the South of Brazil

OBJECTIVE

 To analyze the cases of all women who attend to a service of legal termination of pregnancy in cases of sexual violence in a public reference hospital and to identify the factors related to its execution.

METHODS

 Cross-sectional observational study with information from medical records from January 2014 to December 2020. A total of 178 cases were included, with an evaluation of the data referring to the women who attended due to sexual violence, characteristics of sexual violence, hospital care, techniques used, and complications. The analysis was presented in relative and absolute frequencies, medians, means, and standard deviation. Factors related to the completion of the procedure were assessed using binary logistic regression.

RESULTS

 Termination of pregnancy was performed in 83.2% of the cases; in 75.7% of the cases, the technique used was the association of transvaginal misoprostol and intrauterine manual aspiration. There were no deaths, and the rate of complications was 1.4%. Gestational age at the time the patient's sought assistance was the determining factor for the protocol not being completed. Pregnancies up to 12 weeks were associated with a lower chance of the interruption not occurring (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.12-0.88), while cases with gestational age > 20 weeks were associated with a greater chance of the interruption not happening (OR: 29.93; 95%CI: 3.91-271.50).

CONCLUSION

 The service studied was effective, with gestational age being the significant factor for resolution.

Fetal ultrasound estimated weight and correlation to Brazilian newborn weight

Background: To compare the best fetal weight formula with different biometric tables on the weight of Brazilian newborns. Methods: This observational study has tested the performance of different common fetal weight formulas and biometric tables. Weight estimates were performed by the methods of Warsof et al. (1977), Shepard et al. (1982), Hadlock et al. (1985), Furlan et al. (2012) and Stirnemann et al. (2017). The biometric tables selected were the following: Snijders and Nicolaides (1994), Hadlock et al. (1984), Papageorghiou et al. (2014) and Kiserud et al. (2016) and correlated to Pedreira et al. (2011) database, which was considered the gold standard. Statistical analyses were performed using the mean relative error, average absolute error and the Pearson correlation coefficient (r). Results: The best r was found when using the Snijders and Nicolaides (1994) biometric table with weight formula by Stirnemann et al. (2017). The average relative error was lower when using weight formula by Shepard et al. (1982) with biometric tables by Snijders and Nicolaides (1994), Papageorghiou et al. (2014) or Kiserud et al. (2016). On average, absolute error, the lowest r was obtained for the Furlan et al. (2012) weight formula and the Papageorghiou et al. (2014) biometric table. Conclusions: The best correlation was found for biometric table by Snijders and Nicolaides (1994) and fetal weight formula calculation for the estimation of Brazilian newborn weight by Stirnemann et al. (2017).

Background: To compare the best fetal weight formula with different biometric tables on the weight of Brazilian newborns. Methods: This observational study has tested the performance of different common fetal weight formulas and biometric tables. Weight estimates were performed by the methods of Warsof et al. (1977), Shepard et al. (1982), Hadlock et al. (1985), Furlan et al. (2012) and Stirnemann et al. (2017). The biometric tables selected were the following: Snijders and Nicolaides (1994), Hadlock et al. (1984), Papageorghiou et al. (2014) and Kiserud et al. (2016) and correlated to Pedreira et al. (2011) database, which was considered the gold standard. Statistical analyses were performed using the mean relative error, average absolute error and the Pearson correlation coefficient (r). Results: The best r was found when using the Snijders and Nicolaides (1994) biometric table with weight formula by Stirnemann et al. (2017). The average relative error was lower when using weight formula by Shepard et al. (1982) with biometric tables by Snijders and Nicolaides (1994), Papageorghiou et al. (2014) or Kiserud et al. (2016). On average, absolute error, the lowest r was obtained for the Furlan et al. (2012) weight formula and the Papageorghiou et al. (2014) biometric table. Conclusions: The best correlation was found for biometric table by Snijders and Nicolaides (1994) and fetal weight formula calculation for the estimation of Brazilian newborn weight by Stirnemann et al. (2017).

Childbirth, Puerperium and Abortion Care Protocol during the COVID-19 Pandemic

The new coronavirus (severe acute respiratory syndrome-related coronavirus 2, SARS-CoV-2) is a virus that causes a potentially serious respiratory disease that has spread in several countries, reaching humans in all age groups, including pregnant women. The purpose of this protocol is to provide technical and scientific support to Brazilian obstetricians regarding childbirth, postpartum and abortion care during the pandemic.

Pyelonephritis in Pregnancy: Clinical and Laboratorial Aspects and Perinatal Results

Objective To identify the prevalence of pyelonephritis during pregnancy and to analyze the clinical and laboratorial aspects, perinatal results and complications.

Methods A transversal study of 203 pregnant women who had pyelonephritis during pregnancy and whose labor took place between 2010 and 2016 at a hospital in the state of Santa Catarina, Brazil. The analysis was based on medical records as well as on the hospital's database. Clinical and laboratory conditions, antibiotics, bacterial resistance, perinatal outcomes and complications were all taken into account. The data was compared using the Mann-Whitney test and the Chi-square test.

Results A prevalence of 1.97% with pyelonephritis was evidenced, with most patients having it during the second trimester of gestation. The bacteria most commonly found in the urine cultures was Escherichia coli, in 76.6% of cases, followed by Klebsiella pneumoniae (8.7%). Ceftriaxone had the lowest bacterial resistance (only 3.5% of the cases). On the other hand, ampicillin and cephalothin presented higher bacterial resistance, 52% and 36.2%, respectively. The risk of very premature delivery was more than 50% higher in patients with pyelonephritis.

Conclusion Ampicillin and first-generation cephalosporins are associated with a higher bacterial resistance while ceftriaxone proved to have a high efficacy for the treatment of pyelonephritis due to low bacterial resistance. Patients with pyelonephritis showed a higher risk for very premature delivery (< 32 weeks). In this casuistry, there were no others significant differences in the overall perinatal outcomes when compared with the routine service series.