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Correlation between Late Cord Clamping and Phototherapy and Other Neonatal Unfavorable Outcomes: A Randomized Clinical Trial

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Open Journal of Obstetrics and Gynecology 2022年第3期12卷 193-200页

作者： Janete Vettorazzi Gabriela Françoes Rostirolla Maria Alexandrina Zanatta edimárlei gonsales valério Charles Francisco Ferreira Jose Geraldo Lopes Ramos Postgraduation Program in Health Sciences: Gynecology and Obstetrics Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil Department of Gynecology and Obstetrics Faculty of Medicine (FAMED) Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil Department of Gynecology and Obstetrics Faculty of Medicine (FAMED) Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil Department of Gynecology and Obstetrics Faculty of Medicine Universidade de Caxias do Sul (UCS)

Background: Recently, late umbilical cord clamping is generally recommended, which decreases neonatal anemia;however, it may also increase neonatal jaundice and some other poor outcomes. Objectives: We here attempted to determine whether late clamping actually increases the incidence of phototherapy for jaundice and other poor outcomes of the term “low-risk newborns”. Methods: With the approval of the Brazilian Registry of Clinical Trials (REBEC), a total of 357 low-risk newborns (singleton, uncomplicated pregnancy/delivery, in a Brazilian public institution) were randomized into two groups: group I (n = 114): cord clamping 1 minute (early clamping) or group II (n = 243): cord clamping between 1 - 3 minutes (late clamping). Statistics were used appropriately (i.e., measures of central tendency, dispersion for continuous variables, Shapiro-Wilk, Mann-Whitney test, or Chi-square test). Results: Phototherapy was performed in 5.3% in both groups. Also, there were no statistical differences in the occurrence of secondary outcomes, such as sepsis, neonatal ICU admission, and transient tachypnea of the newborns: i.e., 0.9%, 15.8%, and 3.5%, respectively for group I versus 1.2%, 15.6%, and 5.8%, respectively for group II. Conclusion: Late umbilical cord clamping does not increase the need for phototherapy in low-risk neonates. This result corroborates the current recommendation of late cord clamping, whenever appropriate.

关键词： Phototherapy Neonatal Anemia Neonatal Jaundice Late Cord Clamping

Necrotizing Fasciitis in the Puerperium of a Woman with Complement Deficiency: Case Report and Review Literature

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Open Journal of Obstetrics and Gynecology 2018年第12期8卷 1236-1246页

作者： Janete Vettorazzi edimárlei gonsales valério Gustavo Adolpho Moreira Faulhaber Amanda Vilaverde Perez Mariana Sbaraini Daniela Vanessa Vettori Postgraduation Program in Health Sciences: Gynecology and Obstetrics Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil Department of Gynecology and Obstetrics Faculty of Medicine (FAMED) Universidade Federal do Rio Grande do Sul Porto Alegre Brazil Faculty of Medicine (FAMED) Universidade Federal do Rio Grande do Sul Porto Alegre Brazil Service of Obstetrics and Gynecology Hospital de Clínicas de Porto Alegre (HCPA) Porto Alegre Brazil

Complement deficiencies are uncommon types of primary immunodeficiency. Necrotizing fasciitis is a rare complication in pregnancy characterized by soft tissue invasion and necrosis of the subcutaneous and other adjacent tissues, leading to high mortality rates. We report a case of a 29-year-old pregnant woman with functional deficiency of the C4 complement component and short uterine cervix. Admitted at the hospital with preterm labor, she received multiple doses of immunoglobulin. After 8 weeks, she had a premature membrane rupture, and due to pelvic presentation she had a cesarean. The patient presented multiple obstetric complications, such as operative wound infection, endometritis, sepsis, necrotizing fasciitis and pelvic septic thrombophlebitis. She underwent multiple antimicrobial schemes, a hysterectomy and 4 extensive debridements of the abdominal wall because of significant necrosis. She stayed at the hospital for 101 days (32 of those in ICU in immediate postpartum). 41 days after cesarean, patient was discharged in good conditions. Our case emphasizes individual handling and high multiple doses of immunoglobulin for favorable outcome of the case.

关键词： Pregnancy Immunodeficiency C4 Factor C4 Deficiency Necrotizing Fasciitis Puerperal Infection

Maternal Effects of Immediate versus Delayed Umbilical Cord Clamping: A Randomized Clinical Trial

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Open Journal of Obstetrics and Gynecology 2021年第11期11卷 1500-1511页

作者： Gabriela Françoes Rostirolla Maria Alexandrina Zanatta Charles Francisco Ferreira José Geraldo Lopes Ramos edimárlei gonsales valério Janete Vettorazzi Postgraduation Program in Health Sciences: Gynecology and Obstetrics (PPGGO) Faculdade de Medicina (FAMED) Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brasil Universidade de Caxias do Sul (UCS) Caxias do Sul Brasil Gynecology and Obstetrics Department Clinical Hospital of Porto Alegre (HCPA) Faculdade de Medicina (FAMED) Universidade Federal do Rio Grande do Sul Rio Grande do Sul (UFRGS) Porto Alegre Brasil

OBJECTIVE: To compare maternal preoperative and postoperative hemoglobin variation after cord clamping. METHODS: Randomized clinical trial performed in Porto Alegre, RS from January to December 2012. It was included 356 women with habitual risk gestations. In the immediate cord clamping group, the umbilical cord section was realized between 0 and 60 s (group 1) while in the delayed cord clamping group it was realized >60 s (group 2). RESULTS: The mean (±standard deviation [SD]) preoperative hemoglobin was 12.13 ± 1.06 in the group 1 and 12.13 ± 1.11 in the group 2. The mean (±SD) postoperative day 2 hemoglobin level was 10.19 ± 1.46 in the group 1 and 10.24 ± 1.42 in the group 2. CONCLUSIONS: Delayed umbilical cord clamping resulted in a similar maternal hemoglobin level reduction at postoperative day 2.

关键词： Cord Clamping Delayed Cord Clamping Immediate Cord Clamping Matern Hemoglobin Level

Midline Supraumbilical Incision as an Option for Morbidly Obese Patients? Case Report

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Open Journal of Obstetrics and Gynecology 2021年第11期11卷 1517-1523页

作者： Janete Vettorazzi Gabriela Françoes Rostirolla Gabrielle Soares Behenck Fernanda Oliveira Castilhos Eduardo Vettorazzi-Stuczynski edimárlei gonsales valério Postgraduate Program in Health Sciences: Gynecology and Obstetrics Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brasil Department of Gynecology and Obstetrics Faculdade de Medicina (FAMED) Universidade Federal do Rio Grande do Sul Porto Alegre-Rio Grande do Sul (RS) Brasil Service of Obstetrics and Gynecology Hospital de Clínicas de Porto Alegre Porto Alegre/RS Brasil Hospital Geral de Caxias do Sul e Faculdade de Medicina da Universidade de Caxias do SUl Caxias do Sul/RS Brasil

Background: Nowadays we observe growing rates of obesity, mainly among women. It has a great impact on maternal and fetal morbimortality and requires a specific obstetric approach. Aim: To discuss different approaches to abdominal incision in cesarean section in obese patients. Case presentation: Patient with morbid obesity submitted to an elective cesarean section due to fetal macrosomia and who underwent a cesarean section with a supraumbilical median incision evolving without any postpartum complications. Conclusion: It’s important to evaluate and chose the best incision in morbidly obese pregnant women aiming to reduce difficulties in fetal extraction and postoperative complications. Midline supraumbilical incision is a good choice in these cases, reducing surgical time and postpartum hemorrhage.

关键词： Obesity Caesarean Section Surgical Incision Abdominal Obesity

Acute Generalized Exanthematous Pustulosis during Puerperal Period Induced by Azithromycin: Case Report

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Open Journal of Obstetrics and Gynecology 2018年第12期8卷 1156-1162页

作者： Janete Vettorazzi edimárlei gonsales valério Michele Luz Kayser Luíza Guazzelli Pezzali Daniela Vanessa Vettori Gabriela Francoes Rostirolla Postgraduate Program in Health Sciences: Gynecology and Obstetrics Federal University of Rio Grande do Sul (UFRGS) Porto Alegre Brazil Department of Gynecology and Obstetrics Faculty of Medicine (FAMED) Federal University of Rio Grande do Sul (UFRGS) Porto Alegre Brazil Service of Gynecology and Obstetrics Hospital de Clínicas de Porto Alegre (HCPA) Porto Alegre Brazil

Background: The use of antibiotics, especially beta-lactams and macrolides, may be associated with dermatopathies, such as Acute Generalized Exanthematous Pustulosis (AGEP), which is an uncommon cutaneous adverse reaction. Case: We report a case of AGEP, in a 36-year-old multiparous (G5P3C1A1) woman, with 38 weeks of gestation, admitted to the hospital to induce labor. Due to cephalopelvic disproportion, the cesarean section was indicated. In the postoperative period, the patient evolved with cutaneous rash, accompanied by productive cough and dyspnea. Because it was a fever of obscure origin, the treatment with antibiotics, including azithromycin, was initiated. On subsequent days, she presented pustules on the back, abdomen and extremities. Such reaction was attributed to the use of azithromycin. When the drug was discontinued, the lesions regressed significantly. Conclusion: The clinical picture of AGEP may occur with persistent high fever and therefore could be confused with systemic infections, consequently, being treated with wrong medications capable of aggravating the adverse cutaneous reaction, worsening the course of the disease that could be easily treated by stopping the use of the causative drug. This case shows the importance of including AGEP as a differential diagnosis of dermatopathies in the pregnancy-puerperal cycle, especially in women who are using various medications, including antibiotics.

关键词： Acute Generalized Exanthematous Pustulosis Dermatopathy High-Risk Gestation Case Report

First Experience Using Brazilian Ingamed<sup>&reg</sup>Cervical Pessary in Twin Pregnancy: A Case Series

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Open Journal of Obstetrics and Gynecology 2018年第13期8卷 1282-1288页

作者： Janete Vettorazzi Cristiano Caetano Salazar edimárlei gonsales valério Ana Lúcia Isotton Anthomy Petermann Marcos Wengrover Rosa Gabriela Francoes Rostirolla Postgraduation Program in Health Sciences Gynecology and Obstetrics Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil Department of Gynecology and Obstetrics Medical School of UFRGS Porto Alegre Brazil Service of Gynecology and Obstetrics Hospital de Clínicas de Porto Alegre Porto Alegre Brazil Service of Obstetrics and Gynecology Hospital Moinhos de Vento Porto Alegre Brazil Medicina Fetal Porto Alegre Porto Alegre Brazil

Background: The rate of prematurity in twin pregnancies is higher than 50%. Due to its multifactorial nature, different strategies are necessary to reduce the incidence of premature birth or to increase the gestational age at birth of pregnancies at risk. In this context, cervical pessary may be indicated in twin pregnancies with short cervix. Methods: In this case series, we describe six twin pregnancies that were considered as high-risk for preterm labor due to short cervix (CL at second trimester and multiple risk factors for prematurity. Several strategies were associated for the goal of delaying gestational age at birth. The main strategies were: removal of labor activities, treatment of infections, vaginal micronized progesterone 400 mg/day and vaginal pessary insertion (Ingamed®?Brazil). Results: The gestational age of insertion of the pessary ranged from 16 to 24 weeks. The gestational age of birth ranged from 26 to 34 weeks. Three of the pregnancies were delivered due to spontaneous onset of labor, and three were delivered due to medical reasons. The mean length of pregnancy since pessary insertion to birth was 9 weeks (range 2 to 17 weeks). All infants without severe fetal malformation were discharged from the hospital without major sequelae. Conclusion: The use of cervical pessaries associated to micronized progesterone at a dose of 400 mg/day may be an option in the management of twins at risk for preterm birth. More controlled studies are needed to evaluate the simultaneous use of cervical pessary and progesterone on twin pregnancies.

关键词： Cervical Pessary Ingamed Pessary Progesterone Twin Pregnancy Preterm Birth

The Effects of Lichen Sclerosus and Its Treatments on Sexuality: Case Report

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Open Journal of Obstetrics and Gynecology 2019年第6期9卷 755-763页

作者： Janete Vettorazzi edimárlei gonsales valério Amanda Vilaverde Perez Mariana Sbaraini Luciana Segat Daniela Vanessa Vetori Fernanda Santos Grossi valentino Antonio Magno Postgraduation Program in Health Sciences: Gynecology and Obstetrics Universidade Federal do Rio Grande do Sul (UFRGS). Rua Ramiro Barcelos Santa Cecilia Porto Alegre RS Brazil Department of Gynecology and Obstetrics Faculty of Medicine (FAMED) UFRGS Rua Ramiro Barcelos Santa Cecilia Porto Alegre RS Brazil FAMED UFRGS Rua Ramiro Barcelos Santa Cecilia Porto Alegre RS Brazil Service of Obstetrics and Gynecology Hospital de Clínicas de Porto Alegre (HCPA) Rua Ramiro Barcelos Santa Cecília Porto Alegre RS Brazil

Lichen sclerosus is a chronic and autoimmune dermatitis that develops in the anogenital region. It is related to genital alterations with repercussions in sexuality. We present a case of a 60-year-old woman who had several chronic diseases and had been diagnosed with vulvar lichen sclerosus for 20 years, with no response to multiple treatments (topical corticosteroids, immunomodulators). She was submitted to vulvectomy;however, it leads to worsening of her condition, presenting obliterated and fibrosed clitoris, atrophic vaginal lips, and anal and vulvar fissures. She remained with dyspareunia, decreased sexual desire and difficulty in orgasm. She underwent sexual therapy, adjustment of antidepressant medication and made intercalated use of topical corticosteroids, topical testosterone and vaginal moisturizers, with partial improvement. From this case we can conclude that, although vulvectomy can be related to some degree of improvement in patients with lichen sclerosus, serious complications can occur.

关键词： Lichen Sclerosus Dyspareunia Corticosteroids Vulvectomy

Sexual Function in Pregnant Women in the Public Health System

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Open Journal of Obstetrics and Gynecology 2019年第6期9卷 764-774页

作者： Candice Cezimbra Miranda Amanda Vilaverde Perez Bruno Ribeiro Bossardi Luiza Cabreira Brust Fernanda Santos Grossi edimárlei gonsales valério Janete Vettorazzi Maria Celeste Osório Wender PostgraduationProgram in Health Sciences: Gynecology and Obstetrics Universidade Federal do Rio Grande do Sul (UFRGS). Rua Ramiro Barcelos Santa Cecilia Porto Alegre RS Brazil FAMED UFRGS Rua Ramiro Barcelos Santa Cecilia Porto Alegre RS Brazil Department of Gynecology and Obstetrics Faculty of Medicine (FAMED) UFRGS Rua Ramiro Barcelos Santa Cecilia Porto Alegre RS Brazil Service of Obstetrics and Gynecology Hospital de Clínicas de Porto Alegre (HCPA) Rua Ramiro Barcelos Santa Cecília Porto Alegre RS Brazil

Introduction: Pregnancy is a unique situation and involves changes in sexuality. The aim is to evaluate sexual function and satisfaction in pregnant women under prenatal care provided by the public health system. Method: Cross-sectional study with pregnant women receiving ambulatory care in the public health system in the Southern region of Brazil conducted between November 2014 and September 2015. Results: 283 pregnant women were studied. The mean age was 27.7 ± 6.3 years;64% were white and 31.1% were nulliparous. In the total sample, 8.50% were in the first trimester of pregnancy, 37.4% were in the second trimester, and 54.1% were in the third trimester. The rate of global sexual dysfunction (score 26 points) was 55.5%, following the application of The Female Sexual Function Index (FSFI). Sexual dysfunction was significantly more prevalent in the third trimester (62%) compared to the first (33.3%) and second (50.9%) trimesters (p = 0.015). There was a significant difference in all domains, except in the desired domain, according to the trimester. Pregnant women in the third trimester showed significantly lower scores compared to those in the first trimester in the domains with significance. Conclusion: The prevalence of sexual dysfunction among pregnant women in the public system was high. Knowing that more than 50% of the pregnant women presented sexual dysfunction, it is essential to approach sexuality during prenatal care involving the couple.

关键词： Sexual Dysfunction Pregnancy Female Sexual Function Index Sexuality Sexual Function

Hereditary Angioedema in Pregnancy and Management without Recombinant Human C1-INH

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Open Journal of Obstetrics and Gynecology 2021年第11期11卷 1470-1476页

作者： Natália Paseto Pilati Maria Alexandrina Zanatta Daniele Camila Maltauro Gabrielle Behenck edimárlei gonsales valério Fernanda Oliveira Castilhos Eduardo Vettorazzi-Stuczynski Daniela Vanessa Vettori Janete Vettorazzi Postgraduation Program in Health Sciences: Gynecology and Obstetrics (PPGGO) Faculdade de Medicina (FAMED) Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Rio Grande do Sul Brazil Service of Gynecology Hospital de Clinicas de Porto Alegre Porto Alegre Brazil Hospital Geral de Caxias do Sul e Faculdade de Medicina da Universidade de Caxias do Sul Caxias do Sul Brazil

A pregnant woman diagnosed with type 1 angioedema seeks care at a public hospital for planning the delivery. This report presents ways to prevent and manage an acute HAE crisis during childbirth and early postpartum w... 详细信息

关键词： Hereditary Angioedema (HAE) C1-Inhibitor High-Risk Pregnancy Prophylaxis