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Master's Dissertation
DOI
10.11606/D.5.2018.tde-28092018-095912
Document
Author
Full name
Maira Marinho Freire Costa
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2018
Supervisor
Committee
Carvalho, Mário Henrique Burlacchini de (President)
Nomura, Marcelo Luis
Brizot, Maria de Lourdes
Cabar, Fábio Roberto
Title in Portuguese
Cerclagem de emergência: resultados gestacionais, neonatais e fatores prognósticos
Keywords in Portuguese
Âmnio
Cerclagem cervical
Emergências
Gravidez de alto risco
Incompetência do colo do útero
Nascimento prematuro
Abstract in Portuguese
Objetivos: Avaliar e descrever os desfechos maternos e neonatais de gestantes com diagnóstico de cervicodilatação precoce submetidas à cerclagem de emergência ou à conduta expectante com repouso. Avaliar os fatores relacionados com melhores resultados nas gestantes submetidas à cerclagem de emergência. Métodos: Análise retrospectiva de gestantes internadas na Clínica Obstétrica do HCFMUSP, entre 2001 e 2017, com diagnóstico de cervicodilatação precoce e/ou bolsa protrusa. Foram incluídas gestantes com feto único, entre 16 semanas e 25 semanas e 6 dias, com dilatação cervical entre 1 e 3 cm e excluídas gestantes que evoluíram para parto ou aborto em até 2 dias após a internação. Resultados: O estudo envolveu 30 gestantes, 19 no grupo cerclagem e 11 no grupo repouso. Houve diferença significativa entre os grupos para dois dos desfechos primários, com o grupo cerclagem apresentando os melhores resultados: idade gestacional no parto 28,65 versus 23,35 semanas (p=0,031), latência entre a internação e o aborto/parto 48,63 versus 16 dias (p=0,016). Dentro do grupo cerclagem, as gestantes sem bolsa protrusa apresentaram maior idade gestacional no parto: 33,91 versus 26,82 semanas (p=0,032). Na comparação de gestantes com desfecho favorável e desfavorável entre aquelas submetidas à cerclagem, não houve diferença significante para os fatores de risco analisados (antecedentes obstétricos, dilatação cervical, exames laboratoriais ou corioamnionite clínica). Conclusões: A cerclagem de emergência foi superior que à conduta expectante no tratamento de gestantes com cervicodilatação precoce no segundo trimestre da gestação, apresentando melhores resultados gestacionais. Dentre as gestantes submetidas à cerclagem, a ausência de bolsa protrusa esteve relacionada a maior prolongamento da gestação. Não foi possível caracterizar fatores de risco para o sucesso da cerclagem (determinado como taxa de "bebê em casa")
Title in English
Emergency cerclage: gestational and neonatal outcomes and prognostic factors
Keywords in English
Cervical cerclage
Emergencies
Pregnancy high-risk
Premature birth
Uterine cervical incompetence, Amnion
Abstract in English
Objectives: To evaluate and describe the maternal and neonatal outcomes of pregnant women with early cervical dilatation diagnosis submitted to emergency cerclage or to expectant management with bedrest. To evaluate factors related to better outcomes in pregnants submitted to emergency cerclage. Methods: Retrospective analysis of pregnants hospitalized at the Obstetrics Clinic of HCFMUSP between 2001 and 2017 with diagnosis of early cervical dilatation and/or protruding membranes. Pregnants of singleton gestation between 16 weeks and 25 weeks and 6 days, with cervical dilatation of 1 to 3 cm were included. Those ones who have had delivery or miscarriage within 2 days after admission were excluded. Results: The study involved 30 pregnant women, 19 in the cerclage group and 11 in the rest group. There was a significant difference between groups for 2 of the primary outcomes, with the cerclage group showing the best results: gestational age at delivery 28.65 versus 23.35 weeks (p=0.031), latency between hospitalization and abortion / delivery 48.63 versus 16 days (p=0.016). In cerclage group, pregnants without protruding membranes presented higher gestational age at delivery: 33.91 versus 26.82 weeks (p=0.032). In comparison of patients with favorable and unfavorable outcome between those submitted to cerclage, there was no significant difference for the risk factors analyzed (obstetric history, cervical dilatation, laboratory exams or clinical chorioamnionitis). Conclusions: Emergency cerclage was superior to expectant management in the treatment of pregnants with early cervical dilatation in the second trimester of gestation, with better gestational outcomes. Among the pregnants submitted to cerclage, the absence of a protruding membranes was related to a better prolongation of gestation. It was not possible to characterize risk factors for cerclage success (determined as take-home baby rate)
 
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Publishing Date
2018-09-28
 
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