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- Advanced Maternal Age: Adverse Outcomes of Pregnancy, A Meta-AnalysisPublication . Pinheiro, RL; Areia, AL; Mota Pinto, A; Donato, HINTRODUCTION: The risks of pregnancy in women of advanced maternal age are not consensual amongst studies. The aim of this metaanalysis was to determine whether women of advanced maternal age (≥ 35 years old) had worse obstetrical and perinatal outcomes than non- advanced maternal age women (20 - 34 years old) in singleton, naturally-conceived pregnancies. MATERIAL AND METHODS: We searched PubMed/ MEDLINE, IndexRMP and the Cochrane Database of Systematic Reviews. Ten studies were included according to the following criteria: population of > 1000 nulliparous and/or multiparous women with singleton gestations who did not undergo any type of infertility treatment. Using Review Manager v. 5.3, two meta-analysis were performed: one comparing the outcomes of 20 - 34-year-old vs 35 - 40-year-old women, and another comparing the outcomes of 35 - 40-year-old women vs > 40-year-old women. RESULTS: Women aged 35 - 40 years old were more likely to have > 12 years of education than 20 - 34 years old and > 40 years old women. Advanced maternal age women (35 - 40 and > 40 years old) were more likely to be overweight and having gestational diabetes and gestational hypertension. They were also more likely to undergo induced labour and elective caesarean deliveries. Furthermore, they had worse perinatal outcomes such as preterm delivery, low birthweight babies, higher rates of Neonatal Intensive Care Unit admission and worse Apgar scores. Advanced maternal age women had higher rates of perinatal mortality and stillbirth. DISCUSSION: Most authors present similar results to our study. Although the majority of adverse outcomes can be explained through the physio-pathological changes regarding the female reproductive apparatus that come with aging and its inherent comorbidities, according to the existing literature advanced maternal age can be an independent risk factor per se. In older pregnant women without comorbidities such as gestational hypertension or diabetes there are still worse obstetric and perinatal outcomes, which indicate that advanced maternal age is an independent strong risk factor alone. CONCLUSION: Advanced maternal age women are at a higher risk of adverse obstetrical and perinatal outcomes. In both comparisons, worse outcomes were more prevalent in the older group, suggesting that poorer outcomes are more prevalent with increasing age.
- Triplet pregnancies: perinatal outcome evolutionPublication . Almeida, P; Domingues, AP; Belo, A; Fonseca, E; Moura, PPURPOSE: To evaluate the obstetric and perinatal outcomes evolution of triplet pregnancies. METHODS: A prospective observational study was conducted in triplet pregnancies delivered over 16 years in a tertiary obstetric center with differentiated perinatal support. Evaluation of demographic factors, obstetric complications, gestational age at delivery, mode of delivery, birth weight and immediate newborn outcome were done over a 16 years period. A global characterization of the sample was performed considering the listed parameters. Variables were categorized in three groups according to year of occurrence: 1996-2000, 2001-2006, 2007-2011, and all parameters were compared. RESULTS: Of the 33 triplets included, 72.7% resulted from induced pregnancies. All except one patient received prenatal corticosteroids and five received tocolytics. All women delivered prenatally and no significant differences were seen in the mean gestational age at delivery or birth weight towards time. There were three intrauterine fetal deaths. Neonatal immediate outcomes were not significantly different over the years. CONCLUSION: Despite remarkable progresses in perinatal and neonatal cares, no noticeable impact in triplet gestations' outcomes was seen, sustaining that triplets should be avoided due to their great risk of prematurity and neonatal morbidities, either by limiting the numbers of embryos transferred or by fetal reduction.
- Retinopatia da Prematuridade numa Unidade de Cuidados Intensivos Neonatais: Experiência de Oito AnosPublication . Moinho, R; Morais, S; Monteiro, M; Mimoso, GIntrodução: A retinopatia da prematuridade ocorre por inadequada vascularização da retina dos recém-nascidos prematuros. É uma doença multifatorial, com risco inversamente proporcional à idade gestacional e ao peso de nascimento. Objetivos: Caracterizar uma amostra de prematuros com critérios de observação oftalmológica e identificar os principais fatores de risco de retinopatia da prematuridade. Métodos: Estudo descritivo de análise retrospetiva. Consulta dos processos dos prematuros internados de 2005 a 2012 com critérios de observação oftalmológica e colheita de dados demográficos, fatores de risco, observação oftalmológica, estadio da retinopatia e tratamento. Análise estatística: SPSS®v21, significância: p<0,05. Resultados: Obtiveram-se 343 prematuros, 54% do sexo masculino. A incidência de retinopatia foi 15,5%, grave em 2,6%. O grupo com retinopatia teve média de idade gestacional de 27,5±1,9 semanas e peso de nascimento de 937±264 gramas e o grupo sem retinopatia teve, respetivamente, 29,8±1,9 semanas e 1216 ± 277 gramas (p<0,001). Os fatores com diferença entre os dois grupos foram: oxigenoterapia (p<0,001), ventilação invasiva (p=0,003) e sua duração (p<0,001), surfactante (p<0,001), dificuldade respiratória (p<0,001), sépsis tardia (p=0,019), persistência do canal arterial (p<0,001) e seu tratamento médico (p<0,001). A regressão logística mostrou que a idade gestacional é o fator de risco com maior repercussão na ocorrência de retinopatia (OR:0,542). O grau máximo de retinopatia foi 3 com doença plus, tendo 8 prematuros sido submetidos a cirurgia. Discussão e conclusão: A incidência de retinopatia foi inferior a outros estudos. Confirma-se a importância de alguns fatores de risco, sendo a idade gestacional o fator mais determinante.
- Newborn Urinary Metabolic Signatures of Prematurity and Other Disorders: A Case Control StudyPublication . Diaz, SO; Pinto, JJ; Barros, AS; Morais, E; Duarte, D; Negrão, F; Pita, C; Almeida, MC; Carreira, IM; Spraul, M; Gil, AMThis work assesses the urinary metabolite signature of prematurity in newborns by nuclear magnetic resonance (NMR) spectroscopy, while establishing the role of possible confounders and signature specificity, through comparison to other disorders. Gender and delivery mode are shown to impact importantly on newborn urine composition, their analysis pointing out at specific metabolite variations requiring consideration in unmatched subject groups. Premature newborns are, however, characterized by a stronger signature of varying metabolites, suggestive of disturbances in nucleotide metabolism, lung surfactants biosynthesis and renal function, along with enhancement of tricarboxylic acid (TCA) cycle activity, fatty acids oxidation, and oxidative stress. Comparison with other abnormal conditions (respiratory depression episode, large for gestational age, malformations, jaundice and premature rupture of membranes) reveals that such signature seems to be largely specific of preterm newborns, showing that NMR metabolomics can retrieve particular disorder effects, as well as general stress effects. These results provide valuable novel information on the metabolic impact of prematurity, contributing to the better understanding of its effects on the newborn's state of health.
- Neonatal Morbidity in Term Newborns Born by Elective Cesarean SectionPublication . Resende, C; Santos, L; Santos-Silva, IINTRODUCTION: International guidelines suggest that non-urgent planned deliveries be scheduled at or after 39 weeks. Despite this recommendation elective cesarean often occurs before 39 weeks. Some research has demonstrated that elective cesarean before 39 weeks poses a greater risk to the infants than at or after 39 weeks. OBJECTIVE: To evaluate neonatal morbidity in term newborns born by elective cesarean section. MATERIAL AND METHODS: Retrospective study of all term elective cesarean sections (scheduled and without labor) performed in level III maternity, in the last 11 years (2003 - 2013). High risk pregnancies were excluded: twins, premature rupture of membranes, preeclampsia, poorly controlled diabetes mellitus, Rh isoimmunization and congenital malformations. Two groups of newborns with gestational age less than 39 weeks and equal or greater than 39 weeks gestational age were compared. RESULTS: In our sample, 45% of elective caesarean sections were performed before 39 weeks. Infants born before 39 weeks were more frequently admitted in neonatal intensive care, odds ratio 2.4 [1.4 - 4.1] p = 0.001, had more respiratory morbidity, odds ratio 2.4 [1.6 - 3.8] p < 0.001, more hyperbilirubinaemia odds ratio 2.3 [1.5 - 3.7] p < 0.001, more hypoglycaemia and/or feeding difficulties odds ratio 1.6 [1.2 - 2.4] p = 0.006, and longer admissions (more than five days), odds ratio 2.0 [1.4 - 3] p < 0.001. DISCUSSION: As in other studies 'early term' had higher respiratory and metabolic morbidity and consequently had a longer hospital stay. CONCLUSION: These findings support recommendations to delay elective cesarean delay until 39 weeks of gestation.
- Obstetric litigation: the importance of the quality of clinical files and its influence on expertise conclusionsPublication . Domingues, AP; Moura, P; Vieira, DNTo appreciate the Portuguese circumstances concerning situations of obstetric medico-legal conflicts and to evaluate the influence of the quality of files in expert conclusions, an analysis of all cases of obstetric medical responsibility from 2001-11 was carried out. File quality was evaluated by absence or insufficiency of clinical information supplied, by poor quality of document copies and by the registered incongruities among all the health professionals involved. Clinical files sent for forensic analysis were defective in most cases (89.5%). In about 11% of cases, expert opinion was inconclusive as a result of the poor quality of the clinical files sent for technical and scientific analysis. This situation is particularly serious in cases where the reason for the dispute was asphyxia, traumatic lesions of the newborn following instrumented delivery or shoulder dystocia and maternal sequelae, where the lack or absence of information, and poor quality copies were significantly associated with inconclusive opinions.
- Instability of misoprostol tablets stored outside the blister: a potential serious concern for clinical outcome in medical abortionPublication . Berard, V; Fiala, C; Cameron, S; Bombas, T; Parachini, M; Gemzell-Danielsson, KMisoprostol (Cytotec) is recognised to be effective for many gynaecological indications including termination of pregnancy, management of miscarriage and postpartum haemorrhage. Although not licensed for such indications, it has been used for these purposes by millions of women throughout the world. Misoprostol tablets are most often packaged as multiple tablets within an aluminium strip, each within an individual alveolus. When an alveolus is opened, tablets will be exposed to atmospheric conditions.
- Relational and reproductive trajectories leading to adolescent pregnancy in Portugal: a national and regional characterizationPublication . Pires, R; Pereira, J; Pedrosa, AA; Bombas, T; Vilar, D; Vicente, L; Canavarro, MCINTRODUCTION: The current study aimed to describe the relational and reproductive trajectories leading to adolescent pregnancy in Portugal, and to explore whether there were differences in this process according to adolescents' place of residence. MATERIAL AND METHODS: Data were collected between 2008 and 2013 in 42 public health services using a self-report questionnaire developed by the researchers. The sample consisted of a nationally representative group of pregnant adolescents (n = 459). RESULTS: Regardless of having had one (59.91%) or multiple sexual partners (40.09%), the majority of adolescents became pregnant in a romantic relationship, using contraception at the time of the conception and knowing the contraceptive failure which led to pregnancy (39.22%). In some regions other trajectories were highly prevalent, reflecting options such as planning the pregnancy (Alentejo Region/ Azores Islands), not using contraception (Centro Region/Madeira Islands) or using it incorrectly, without identifying the contraceptive failure (Madeira Islands). On average, romantic relationships were longer than 19 months and adolescents' partners were older than themselves (> 4 years) and no longer in school (75.16%); these results were particularly significant when the pregnancy was planned. DISCUSSION: The knowledge gained in this study shows that prevention efforts must be targeted according to the adolescents' needs in each region and should include high-risk male groups. CONCLUSION: Our results may enable more efficient health policies to prevent adolescent pregnancy in different country regions and support educators and health care providers on sexual education and family planning efforts.
- Twins prematurity--the influence of prenatal surveillancePublication . Domingues, AP; Fonseca, E; Belo, A; Moura, POBJECTIVE: To evaluate the influence of the local prenatal surveillance of twin pregnancies in the obstetrical results. METHODS: A prospective cohort study of multiple pregnancies delivered over a period of 16 years in a tertiary centre was conducted. In this study 861 twin pregnancies were included. They were compared for obstetric complications, gestational age at delivery, mode of delivery and birthweight, according to the place of the surveillance. RESULTS: Of the 861 cases examined, the following obstetric complications were significantly different: metrorrhagia (p = 0.039), infections (p < 0.001), HELLP (p = 0.007), PROMPT (p < 0.001) and fetal death (p = 0.024). The mode of delivery was similar but occurred mostly ≤32 weeks (p < 0.001), the birthweight was mostly <2000 g and occurred more NICU admission (p < 0.001) when surveillance was outside the MPC-MDM. CONCLUSION: Our results demonstrate the crucial importance of prenatal surveillance be carried in a differentiated referral centers with specific/strict protocols or the urgent implementation of same protocols in all other places of surveillance, since this straight surveillance greatly reduces the occurrence of prenatal complications, mainly PROMPT, PTD.
- Monoamniotic twins discordant for body stalk anomalyPublication . Tavares, MV; Domingues, AP; Tavares, M; Fonseca, E; Moura, PBody stalk anomaly is a rare malformation. This anomaly in monozygotic twins is extremely unusual. We describe a case of monoamniotic pregnancy discordant for body stalk anomaly diagnosed at 11 weeks. Ultrasound showed a fetus with a large anterior abdominal wall defect, anomaly of the spine and no evidence of lower extremities and other with a normal morphology. As far as our concern, only three monoamniotic pregnancies discordant for this malformation were reported. Our case represents the fourth reported monoamniotic pregnancy discordant for body stalk anomaly with diagnosis made by ultrasound and the second diagnosed in the first trimester.