[Mother-infant indicators in adolescence and youth: socio-demographic, prenatal, delivery and newborns]

OBJECTIVE: To identify characteristics and associations between maternal age and gestation, delivery, and livebirths of adolescent and young adult mothers in the city of Feira de Santana, state of Bahia, Brazil. METHODS: We carried out a cross-sectional, epidemiological study with a population of livebirths and adolescent mothers (aged 10-16 and 17-19 years) and young adult mothers (aged 20-24 years). The information were obtained from the Livebirths Information System (SINASC-1998) for a total of 5,279 livebirths. Study variables were classified into socio-demographic factors (age, schooling of the mother, sex of the newborn) and related to term, delivery, gestational age, birth weight, and Apgar score. Data were processed using prevalence ratio and multivariate analysis. Logistic regression was used to control confounding factors (prenatal and gestational age) and to establish an association between maternal age and birth weight. RESULTS: In 1998, 21.6% of all livebirths in the city of Feira de Santana were from adolescent mothers; out of these mothers, 51.2% had not finished junior high or elementary school. Prevalence ratio and adjusted odds ratio for the 10-16 years of age group indicated increased prevalence of illiteracy, no prenatal examination, and low birth weight and a low prevalence of adequate weight of the newborn in comparison to other age groups studied. Logistic regression showed a positive association between maternal age and low birth weight. We also observed that the SINASC database lacked information in many different fields. CONCLUSIONS: Our results indicated, for adolescent mothers, a high prevalence of livebirths and low schooling. Also, especially for the 10-16 years of age group, we observed increased risks for illiteracy, no prenatal examinations, low birth weight, and inadequate weight of the newborn in comparison to other age groups.

[Myocardial revascularization surgery via a left minithoracotomy]

PURPOSE

There is, today, a global tendency towards a surgical approach privileging very small incisions, the so-called minimally invasive intervention, which results in a less aggressive action. The introduction of this new technique makes it possible to dissect the left internal thoracic artery (LITA) and to perform in the anastomosis with the anterior interventricular artery (AIA) through a left minithoracotomy.

METHODS

From May of 1996 to october of 1997, 11 patients with ischemic heart disease and a single proximal lesion of the AIA were submitted to a myocardial revascularization (MR). The surgical approach consisted of a left anterolateral thoracotomy through the 4th left intercostal space, of approximately 10 cm, and in the last 6 cases, resection of part of the cartilage of the 4th and 5th ribs, dissection of the LITA, as well as opening and repair of the pericardium adjacent to the AIA was done. All patients received a single bypass to the AIA with a graft of the LITA, without extracorporeal circulation.

RESULTS

The patients' age varied between 46 and 76 years (mean = 58.55). Ten patients (90.90%) were males and 1 (9.09%) was a female. Hospital stay ranged from 4 to 8 days, with the average of 5.2 days. None of the patients presented any electrocardiographic change in the immediate post-operatory period. During the control period one patient developed a clot in the distal LITA, with important compromise of the flow. In another patient the stenosis was at the level of the anastomosis. Both were successfully submitted to angioplasty. There were no deaths in the groups studied.

CONCLUSION

The absence of deaths suggests to us that MR surgery carried out with this minimally invasive technique, in selected groups and is an excellent alternative to the revascularization of the AIA.

Apoptosis as a function of ovarian reserve in women undergoing in vitro fertilization

OBJECTIVE

To test the hypothesis that preovulatory follicles from women with diminished ovarian reserve contain fewer numbers of luteinized granulosa cells and have a greater percentage of cells undergoing apoptosis as compared with women with uncompromised ovarian reserve undergoing superovulation for IVF-ET.

DESIGN

Comparative study.

SETTING

Academic clinical practice.

PATIENTS

Luteinized granulosa cell counts were determined from follicular aspirates harvested from 19 women with day 3 serum FSH < or = 6 mIU/mL (conversion factor to SI unit, 1.00) and from 15 women with FSH levels > or = 10 mIU/mL. The second part examined the percent of proliferating and apoptotic cells harvested from nine women with day 3 serum FSH < or = 6 mIU/ mL and from eight women with FSH levels > or = 10 mIU/mL.

MAIN OUTCOME MEASURES

Cell counts by hemacytometer and percent of proliferating and of apoptotic granulosa cells by flow cytometry.

RESULTS

The mean number of viable cells isolated per follicle were 2.7 x 10(5) (95% confidence interval [CI] 2.3 to 3.1 x 10(5) from the low FSH group and 1.8 x 10(5) (95% CI 1.4 to 2.3 x 10(5) from the high FSH group. Although the percentage of proliferating cells was the same, the mean percentage of apoptotic cells was 0.5% (95% CI 0.2% to 1.4%) from the low group and 2.0% (95% CI 1.1% to 3.7%) from the high group.

CONCLUSIONS

Women undergoing IVF with day 3 serum FSH > or = 10 mIU/mL have preovulatory follicles with fewer luteinized granulosa cells and an increase in the percentage of cells undergoing apoptosis as compared with women with day 3 serum FSH < or = 6 mIU/mL.