Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg / Background and objectives Prelabour rupture of the membranes (PROM) is a major obstetric problem affecting about 20% of pregnancies. Complications include preterm labour, ascending intrauterine and perinatal infections, and neonatal mortality. Standard guidelines are formulated and continually reviewed to improve the clinical management of PROM and to reduce poor perinatal outcomes associated with this condition. The objectives of this study, conducted using women in Johannesburg as a sample population, were: 1) to audit the implementation of the standard protocol on management of PROM, and 2) to determine the maternal and fetal outcomes of this condition. Methods A cross-sectional descriptive study was done on women admitted to the antenatal wards of Chris Hani Baragwanath Academic Hospital with PROM. Inclusion criteria were that PROM was the main reason for admission, gestation ≥24 weeks, and maternal age 18 years or more. Hospital clinical files were studied for obstetric and clinical characteristics, adherence by doctors to the management protocol, and final outcome including latency period, induction rate, mode of delivery, and neonatal outcome. Results Ninety-seven women participated in the study. Their mean age was 27.0 years, and 37 (38%) were nulliparous. Eighty-five (87%) had attended antenatal clinic. Twenty-nine (30%) were HIV-infected, 23 (79%) of them on highly active antiretroviral treatment. 6 The mean gestational age on admission was 32.8 weeks, with 78 (80%) women having preterm PROM at GA<37 weeks and 52 (54%) at GA <34 weeks. The most frequent methods of diagnosis were visual inspection in 77 (79%), speculum examination in 49 (51%) and ultrasound scan in 81 (84%) of the women. Antibiotics were given to 96 women (99%), and antenatal corticosteroids were used in all women <34 weeks pregnant. No cases of clinical chorioamnionitis were detected. The mean latency from PROM to delivery for women <37 weeks pregnant was 15 days, and for those <34 weeks, it was 19 days. Twenty-nine women (30%) required induction of labour, and 25 (25.8%) had caesarean sections. There were 12 perinatal deaths (with the exclusion of three late neonatal deaths), resulting from prematurity (n=4), congenital anomalies (n=2), neonatal jaundice (n=2), respiratory distress syndrome (n=2) and perinatal asphyxia / hypoxic ischaemic encephalopathy (n=2). There were no recorded cases of either neonatal or puerperal sepsis. Conclusion The study may have under-represented term PROM, so the findings are most applicable to preterm PROM. The condition was mostly managed appropriately within the local protocol, especially in terms of corticosteroid and antibiotic use. Overt or clinically evident chorioamnionitis was not detected. However, the perinatal mortality rate was high, and whatever the causes of perinatal death in this group, it is clear that PROM is a high-risk condition deserving of close clinical attention.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Made available in DSpace on 2016-07-01T13:10:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-04-24. Added 1 bitstream(s) on 2016-07-01T13:14:07Z : No. of bitstreams: 1 000866191.pdf: 1592677 bytes, checksum: cbfcdb8a7242a22f947e68ab4cde944d (MD5) / Introdução: O Trabalho de Parto Pré-Termo (TPP) e a Rotura Prematura de Membranas Pré-Termo (RPM-PT) acarretam severas complicações para o binômio materno-fetal. Entre os fatores de risco associados ao TPP e à RPM-PT, a predisposição genética vem ganhando importância. Contudo, a associação entre genes polimórficos, ancestralidade e a patogênese do TPP e da RPM-PT permanece alusiva. Objetivo: Determinar a associação entre marcadores informativos de ancestralidade (AIMs) e polimorfismos de nucleotídeo único (SNPs) dos genes da Interleucina-1 beta (IL1B), IL6, Receptor de IL6 (IL6R), Fator de Necrose Tumoral Alfa (TNFA), Receptor de TNF alpha (TNFR), IL10, Receptor Toll-like 2 (TLR2), TLR4, Metaloproteinase 9 (MMP9), Inibidor de Metaloproteinase 1 (TIMP1) e TIMP2 maternos e fetais e o TPP e a RPM-PT. Pacientes e Métodos: Foram coletados swabs bucais de gestantes com TPP e/ou RPM-PT e DE seus filhos (TPP: 137 mulheres e 88 filhos; RPM-PT: 64 mulheres e 44 filhos) atendidas no Hospital das Clínicas da Faculdade de Medicina de Botucatu, UNESP, entre os anos de 2003 e 2014. O grupo controle foi constituído por 201 mulheres que tiveram gestações resolvidas a termo e seus 201 filhos, pareadas ao grupo caso por idade materna e sexo do recém-nascido. O DNA total foi extraído dos swabs bucais e submetido à identificação de AIMs por análise de fragmentos e genotipagem de SNPs utilizando Taqman® SNP Genotyping Assays (Applied Biosystems) e Reação em Cadeia da Polimerase (PCR). O software Structure v2.3.4 foi utilizado para estimar mistura étnica materna. Teste de desequilíbrio de ligação e proporção da Hardy-Weinberg foram testados com Genepop 3.4 e haplótipos inferidos com Phase. Os dados sociodemográficos e biológicos foram comparados utilizando os testes de χ2, teste exato de Fisher, Regressão Logística, Manova, Mann-Whitney e Odds Ratio. Resultados: Nas amostras maternas, o TPP foi associado a maior... / Introduction: A genetic predisposition to Preterm Labor (PTL) and Preterm Premature Rupture of Membranes (PPROM) has been suggested; however the relevance of polymorphisms and ancestry to susceptibility to PTL and PPROM in different populations remains unclear. Objective: To evaluate the association between Ancestry Informative Markers (AIM) and Single Nucleotide Polymorphisms (SNPs) in Interleukin-1 beta (IL1B), IL6, IL6 Receptor (IL6R), Tumor Necrosis Factor Alpha (TNFA), TNF Receptor (TNFR), IL10, Toll Like Receptor 2 (TLR2), TLR4, Metalloproteinase 9 (MMP9), Tissue Inhibitors of Metalloproteinase 1 (TIMP1) and TIMP2 genes and the susceptibility to PTL and PPROM in Brazilian women. Patients and Methods: Oral swabs were collected from women with PTL and/or PPROM and their babies (PTL: 137 women and 88 babies; PPROM: 64 women and 44 babies) seen at the Botucatu Medical School's Hospital, between 2003 and 2014. Control group included 402 mother-babies pairs of term deliveries, matched to case group by age and newborn gender. After DNA extraction, AIMs were identified by fragment analysis and SNPs by Taqman® SNP Genotyping Assays (Applied Biosystems) and Polymerase Chain Reaction (PCR). The software Structure v2.3.4 was used to estimate ethnic admixture of mothers. Linkage Disequilibrium and Hardy-Weinberg proportions were tested with Genepop 3.4 and haplotypes inferred using Phase. Mann-Whitney, χ2, Fisher's exact test, Logistic Regression models, Odds Ratio and Manova were used in data analysis. Results: Regarding maternal samples, PTL was associated to European ancestry and smoking and African ancestry was protective. Regarding ancestry analysis, self-reported ethnicity only explained 20% and 15% of the global variation in African and European contributions, respectively. Fetal IL10-592 C and IL10-819 C were also associated to PTL. Maternal alleles IL10-1082 G and TLR2 A increased the risk ...

Orientador: Márcia Guimarães da Silva / Coorientador: Steven Witkin / Banca: Leandro Gustavo de Oliveira / Banca: Erick da Cruz Castelli / Banca: Rodrigo Paupério Soares de Camargo / Banca: Gisele Alboreghetti Nair / Resumo: Introdução: O Trabalho de Parto Pré-Termo (TPP) e a Rotura Prematura de Membranas Pré-Termo (RPM-PT) acarretam severas complicações para o binômio materno-fetal. Entre os fatores de risco associados ao TPP e à RPM-PT, a predisposição genética vem ganhando importância. Contudo, a associação entre genes polimórficos, ancestralidade e a patogênese do TPP e da RPM-PT permanece alusiva. Objetivo: Determinar a associação entre marcadores informativos de ancestralidade (AIMs) e polimorfismos de nucleotídeo único (SNPs) dos genes da Interleucina-1 beta (IL1B), IL6, Receptor de IL6 (IL6R), Fator de Necrose Tumoral Alfa (TNFA), Receptor de TNF alpha (TNFR), IL10, Receptor Toll-like 2 (TLR2), TLR4, Metaloproteinase 9 (MMP9), Inibidor de Metaloproteinase 1 (TIMP1) e TIMP2 maternos e fetais e o TPP e a RPM-PT. Pacientes e Métodos: Foram coletados swabs bucais de gestantes com TPP e/ou RPM-PT e DE seus filhos (TPP: 137 mulheres e 88 filhos; RPM-PT: 64 mulheres e 44 filhos) atendidas no Hospital das Clínicas da Faculdade de Medicina de Botucatu, UNESP, entre os anos de 2003 e 2014. O grupo controle foi constituído por 201 mulheres que tiveram gestações resolvidas a termo e seus 201 filhos, pareadas ao grupo caso por idade materna e sexo do recém-nascido. O DNA total foi extraído dos swabs bucais e submetido à identificação de AIMs por análise de fragmentos e genotipagem de SNPs utilizando Taqman® SNP Genotyping Assays (Applied Biosystems) e Reação em Cadeia da Polimerase (PCR). O software Structure v2.3.4 foi utilizado para estimar mistura étnica materna. Teste de desequilíbrio de ligação e proporção da Hardy-Weinberg foram testados com Genepop 3.4 e haplótipos inferidos com Phase. Os dados sociodemográficos e biológicos foram comparados utilizando os testes de χ2, teste exato de Fisher, Regressão Logística, Manova, Mann-Whitney e Odds Ratio. Resultados: Nas amostras maternas, o TPP foi associado a maior... / Abstract: Introduction: A genetic predisposition to Preterm Labor (PTL) and Preterm Premature Rupture of Membranes (PPROM) has been suggested; however the relevance of polymorphisms and ancestry to susceptibility to PTL and PPROM in different populations remains unclear. Objective: To evaluate the association between Ancestry Informative Markers (AIM) and Single Nucleotide Polymorphisms (SNPs) in Interleukin-1 beta (IL1B), IL6, IL6 Receptor (IL6R), Tumor Necrosis Factor Alpha (TNFA), TNF Receptor (TNFR), IL10, Toll Like Receptor 2 (TLR2), TLR4, Metalloproteinase 9 (MMP9), Tissue Inhibitors of Metalloproteinase 1 (TIMP1) and TIMP2 genes and the susceptibility to PTL and PPROM in Brazilian women. Patients and Methods: Oral swabs were collected from women with PTL and/or PPROM and their babies (PTL: 137 women and 88 babies; PPROM: 64 women and 44 babies) seen at the Botucatu Medical School's Hospital, between 2003 and 2014. Control group included 402 mother-babies pairs of term deliveries, matched to case group by age and newborn gender. After DNA extraction, AIMs were identified by fragment analysis and SNPs by Taqman® SNP Genotyping Assays (Applied Biosystems) and Polymerase Chain Reaction (PCR). The software Structure v2.3.4 was used to estimate ethnic admixture of mothers. Linkage Disequilibrium and Hardy-Weinberg proportions were tested with Genepop 3.4 and haplotypes inferred using Phase. Mann-Whitney, χ2, Fisher's exact test, Logistic Regression models, Odds Ratio and Manova were used in data analysis. Results: Regarding maternal samples, PTL was associated to European ancestry and smoking and African ancestry was protective. Regarding ancestry analysis, self-reported ethnicity only explained 20% and 15% of the global variation in African and European contributions, respectively. Fetal IL10-592 C and IL10-819 C were also associated to PTL. Maternal alleles IL10-1082 G and TLR2 A increased the risk ... / Doutor

Orientadores: Antonio Wilson Sallum, Jose Guilherme Cecatti / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-06T02:14:55Z (GMT). No. of bitstreams: 1 Vogt_Marianna_M.pdf: 1205544 bytes, checksum: 7e47f127ba99e500264aa494c45e5b69 (MD5) Previous issue date: 2006 / Resumo: Este estudo teve por objetivo avaliar a prevalência de doença periodontal em uma amostra de gestantes de baixo risco gestacional, os fatores a ela associados, e sua correlação com a ocorrência de resultados perinatais adversos, como parto pré-termo, recém-nascido de baixo peso, recém-nascido pequeno para a idade gestacional e amniorrexe prematura. Trata-se de um estudo de coorte com 334 gestantes fazendo acompanhamento pré-natal no Hospital das Clínicas da UNICAMP, que aceitaram participar voluntariamente e tiveram um único exame periodontal realizado no dia da consulta pré-natal. Os dados foram coletados da anamnese, do exame clínico periodontal e de informações relativas à gestação, parto e puerpério. Os parâmetros clínicos periodontais foram: índice de placa, índice de sangramento gengival à sondagem, profundidade de sondagem, nível de inserção clínica periodontal e retração gengival. As gestantes foram divididas em dois grupos: as com periodontite moderada a grave (P2-P4), e as sem doença ou com doença periodontal leve (P0-P1), pela classificação do índice WS. Avaliaram-se também a idade, paridade, raça, escolaridade, estado civil, hábitos alimentares, índice de massa corpórea (IMC), número de consultas de pré-natal, fumo, uso de bebidas e drogas, uso de medicação, vaginose bacteriana e doenças sistêmicas. Inicialmente foi utilizada uma abordagem analítica de corte transversal para a identificação de fatores associados à ocorrência de doença periodontal na gestação. Depois utilizou-se uma abordagem de estudo de coorte propriamente dito, estimando-se o risco de ocorrência dos resultados perinatais desfavoráveis (parto pré-termo, recém-nascido de baixo peso, recém-nascido pequeno para a idade gestacional e amniorrexe prematura, variáveis dependentes principais do estudo) em função da condição periodontal. Foram analisadas as distribuições de freqüência das variáveis independentes pelas categorias de doença periodontal, estimando-se a Razão de Prevalência e seu IC95% para abordagem transversal. Foi então realizada a análise uni e multivariada para a estimativa do risco de ocorrência das variáveis perinatais desfavoráveis na abordagem de coorte, calculando-se a Razão de Risco e seu IC95% para cada uma delas. Foi estabelecido o nível de significância de 5%. A prevalência de periodontite moderada a grave nas 334 gestantes foi de 47%, e se associou significativamente com a idade gestacional mais avançada ao exame periodontal (17-24 semanas: RP 1,40, IC95% 1,01-1,94; e 25-32 semanas: RP 1,52, IC95% 1,10-2,08), com a idade materna entre 25 e 29 anos (RP 1,65, IC95% 1,02-2,68), com a obesidade (RP 1,38, IC95% 1,04-1,82) e com a presença de sangramento gengival (ORajustado 2,01 - IC95% 1,41-2,88). Foram coletados os dados do parto de 327 gestantes e, entre elas, a doença periodontal esteve associada a um maior risco de ocorrência de parto pré-termo (RR 3,47 IC95% 1,62-7,43), de RN de baixo peso (RR 2,93 IC95% 1,36-6,34) e de amniorrexe prematura (RR 2,48 IC95% 1,35-4,56) na análise multivariada. A prevalência de doença periodontal entre gestantes de baixo risco gestacional é alta e associada com a maior idade gestacional, obesidade e sangramento gengival. A doença periodontal foi um fator de risco para a ocorrência de parto pré-termo, RN de baixo peso e de amniorrexe prematura / Abstract: This study was aimed to evaluate the prevalence of periodontal disease in a sample population of low-risk pregnant women, the factors associated with it and its correlation with the occurrence of adverse perinatal outcomes, including preterm births, low birth weigth, small for gestational age babies and premature rupture of the membranes. This cohort study included 334 pregnant women under prenatal care at the Hospital das Clinicas of the University of Campinas, Brazil, who voluntarily accepted to participate and had one single periodontal examination performed in the same day of a prenatal visit. Data was collected from anamnesis, periodontal clinical exam, and from information regarding pregnancy, delivery and postpartum. The clinical periodontal parameters were: plaque index, bleeding on probing index, probing pocket depth, clinical attachment level and gingival recession. Pregnant women were divided into two groups: those with moderate-to-severe periodontitis (P2-P4) and those with no disease or only mild disease (P0-P1), according to the WS classification index. Age, parity, race/color, years of schooling, marital status, number of prenatal visits, dietary habits, BMI (body mass index), smoking habits, use of alcohol and drugs, use of medication and presence of systemic diseases d bacterial vaginosis were also evaluated. Initially a cross sectional analytic approach was used for identifying factors associated with the occurrence of periodontal disease during pregnancy. After that, a real cohort approach was used, with the estimate of the risk of adverse perinatal outcomes (preterm birth, low birth weight, small for gestational age baby and premature rupture of membranes, the main dependent variables of this study) according to the condition of periodontal disease. Distribution of independent variables within the two groups was analyzed by calculating prevalence ratios and their respective 95% confidence intervals for the cross sectional approach. Uni and multivariate analysis for the estimation of the risk of adverse perinatal outcomes were performed for the cohort approach. The Risk Ratior and its 95%CI were estimated for each outcome. The significance level assumed was 5%. The prevalence of moderate to severe periodontitis in 334 pregnant women was 47%, and it was significantly associated with more advanced gestational age at periodontal examination (17-24 weeks: PR 1.40, 95%CI 1.01-1.94; and 25-32 weeks: PR 1.52, 95%CI 1.10 ¿ 2.08), with maternal age between 25 - 29 years (PR 1.65, 95%CI 1.02 ¿ 2.68), with obesity (PR 1.38, 95%CI 1.04 ¿ 1.82) and with the presence of gingival bleeding (ORadjusted 2.01, 95%CI 1.41 ¿ 2.88). The data of 327 deliveries were collected and, among them, the periodontal disease was associated to a higher risk of preterm birth (RR 3.47 95%CI 1.62-7.43), of low birth weight (RR 2.93 95%CI 1.36-6.34) and of premature rupture of membranes (RR 2.48 95%CI 1.35-4.56) in the multivariate analysis. The prevalence of periodontal disease among low-risk pregnant women is high and it is associated with more advanced gestational age, obesity and gingival bleeding. Periodontal disease was a risk factor for the occurrence of preterm birth, low birth weight and premature rupture of membranes / Mestrado / Periodontia / Mestre em Clínica Odontológica