OBJETIVO: Avaliar as relações entre risco gestacional, tipo de parto e suas repercussões maternas e neonatais imediatas. MÉTODOS: Análise retrospectiva de coorte em base de dados secundários, em maternidade de hospital universitário. Foram considerados 1606 partos no período de nove meses. Características epidemiológicas, clínicas, obstétricas e neonatais foram comparadas em função da via de parto e do risco gestacional, caracterizado conforme os critérios de elegibilidade de alto risco clínico. A ocorrência de complicações maternas e neonatais durante a internação foi analisada em função do risco gestacional e parto cesariano. Para isto, análise logística univariada e multivariada foram empregadas. RESULTADOS: A taxa global de cesarianas foi de 38,3%. O alto risco gestacional esteve presente em 50,2% dos partos, representado principalmente pelos distúrbios hipertensivos e as malformações fetais. A ocorrência total de cesarianas, cesarianas anteparto ou intraparto foi mais frequente em gestantes de elevado risco gestacional (p<0,001]. A cesariana, isoladamente, não influenciou o resultado materno, mas associou-se ao resultado neonatal desfavorável (OR 3,4; IC95% 2,7-4,4). O alto risco gestacional associou-se ao resultado materno e neonatal desfavorável (OR 3,8; IC95% 1,6-8,7 e OR 17,5; IC95% 11,6-26,3, respectivamente) Na análise multivariada, essas relações de risco se mantiveram, embora o efeito do risco gestacional tenha determinado uma redução no OR do tipo de parto isoladamente de 3,4 (IC95% 2,66-4,4) para 1,99 (IC95% 1,5-2,6) para o resultado neonatal desfavorável. CONCLUSÃO: O risco gestacional foi o principal fator associado ao resultado materno e neonatal desfavorável. A cesariana não influenciou diretamente o resultado materno, mas aumentou as chances de um resultado neonatal desfavorável.

PURPOSE: To analyze the relationships among gestational risk, type of delivery and immediate maternal and neonatal repercussions. METHODS: A retrospective cohort study based on secondary data was conducted in a university maternity hospital. A total of 1606 births were analyzed over a 9-month period. Epidemiological, clinical, obstetric and neonatal characteristics were compared according to the route of delivery and the gestational risk characterized on the basis of the eligibility criteria for high clinical risk. The occurrence of maternal and neonatal complications during hospitalization was analyzed according to gestational risk and cesarean section delivery using univariate and multivariate logistic analysis. RESULTS: The overall rate of cesarean sections was 38.3%. High gestational risk was present in 50.2% of births, mainly represented by hypertensive disorders and fetal malformations. The total incidence of cesarean section, planned cesarean section or emergency cesarean section was more frequent in pregnant women at gestational high risk (p<0.001). Cesarean section alone did not influence maternal outcome, but was associated with poor neonatal outcome (OR 3.4; 95%CI 2.7-4.4). Gestational high risk was associated with poor maternal and neonatal outcome (OR 3.8; 95%CI 1.3-8.7 and OR 17.5; 95%CI 11.6-26.3, respectively). In multivariate analysis, the ratios were maintained, although the effect of gestational risk has determined a reduction in the OR of the type of delivery alone from 3.4 (95%CI 2.7-4.4) to 1.99 (95%CI 1.5-2.6) for adverse neonatal outcome. CONCLUSION: Gestational risk was the main factor associated with poor maternal and neonatal outcome. Cesarean delivery was not directly associated with poor maternal outcome but increased the chances of unfavorable neonatal outcomes.

OBJETIVO: Pesquisar a prevalência das lesões do ligamento cruzado posterior (LCP) e suas combinações e correlações com o mecanismo e a ocorrência de luxação evidente e fratura associada. MÉTODO: Estudo retrospectivo de 85 lesões do LCP operadas entre 2003 e 2010. Diagnóstico por meio do exame físico e da radiografia dinâmica, confrontados com achados cirúrgicos. RESULTADOS: Lesões que envolveram o LCP foram mais prevalentes nos homens (78,8%) com média de idade de 33 anos. A causa principal foi o acidente de trânsito (73,80%), dos quais 49,4% de motocicleta. Lesão isolada do LCP ocorreu em 15,3% dos casos e combinada em 84,7%. Dentre as lesões isoladas, nove foram avulsões ósseas (10,6%). O ligamento mais associado às lesões do LCP foi o cruzado anterior (48,2%), seguido da lesão combinada do LCP com o ligamento colateral lateral/canto póstero-lateral (22,4%). Fraturas estiveram mais associadas à combinação LCP + LCL/CPL e não apareceram nas lesões do LCP + ligamento colateral medial/canto póstero-medial. Complicações além de fraturas: lesão de nervo periférico (4,8%) e vascular (1,2%). Luxação evidente no primeiro atendimento (16,7%), mais prevalente na combinação LCP + LCA + LCM/CPM (44,4%). Metade dos pacientes foi operada na fase aguda. Houve diferença estatística significativa (p < 0,05) na comparação de cada combinação de lesões de ligamentos com a presença de fratura, luxação evidente ou mecanismo do trauma. CONCLUSÃO: Lesões do LCP submetidas a tratamento cirúrgico em centro de atenção ao trauma ortopédico foram na sua maioria multiligamentares e envolveram principalmente o LCA. Houve associação significativa entre o tipo de lesão com o mecanismo de trauma, a forma de apresentação do joelho, se luxado ou reduzido, e a presença de fratura associada.

OBJECTIVE: To investigate the prevalence and combinations of PCL injuries and their correlations with the mechanism, the occurrence of evident dislocation and associated fracture. METHOD: A retrospective study of 85 lesions of PCL operated between 2003 and 2010. Diagnosis by physical examination and dynamic radiography, compared with surgical findings. RESULTS: Injuries involving the PCL were more prevalent in men (78.8%) with a mean age of 33 years. The main cause was traffic accidents (73.80%), and (49.4%) motorcycle. Isolated PCL injury occurred in (15.3%) cases, and combined (84.7%). Among the isolated lesions, bone avulsions were nine (10.6%). The most associated PCL injuries were the ACL (48.2%), followed by LCL PCL/PLC (22.4%). Fractures were more associated with combining PCL + LCL/PLC injuries and did not appear in the PCL + MCL/PMC. Complications beyond fractures: peripheral nerve injury (4.8%) and vascular (1.2%). Evident dislocation in primary care (16.7%) was more prevalent in combined ACL + PCL + MCL/PMC (44.4%). Half the patients were operated during the acute phase. There was a statistically significant difference (p < 0.05) comparing each combination of ligament injuries with the presence of fracture, dislocation or clear mechanism of injury. CONCLUSION: Surgical treatment of PCL injuries in a center for orthopedic trauma care was mostly multiligament and mainly involving the ACL. A significant association was seen between the type of injury with mechanism of injury, presentation of the knee, if dislocated or reduced, and the presence of associated fracture.

OBJECTIVE: Compare the anti-T. gondii IgG titer between HIV-1 infected and non HIV-1 infected pregnant women and report three cases of congenital toxoplasmosis resulting from reactivation of infection during pregnancy of HIV-1 infected women. METHODS: This study was conducted among 2,270 pregnant women with chronic Toxoplasma gondii infection (absence of IgM and presence of IgG), including 82 HIV-1 infected and 2,188 non-infected women. RESULTS: The average anti-T. gondii IgG titer was 127 for the 2,188 non-HIV-1 infected women, and 227 for the 82 HIV-1-infected women (p = 0,007). These results suggested that higher anti-T. gondii IgG titers in HIV-1-infected pregnant women may not be indicative of an elevated risk for fetal infection. In this study three cases of congenital toxoplasmosis that resulted from infection reactivation during pregnancy of HIV-1-infected women were manifested by fetal death, symptomatic infection, and infant without symptoms, respectively. In two of these women, a ten-fold increase in IgG levels above used cutoff was observed (2,320 UI/mL and 3,613 UI/mL, respectively). In the third pregnant women anti-T. gondii IgG titers during pregnancy did not rise despite the occurrence of congenital toxoplasmosis (204; 198; 172 UI/mL). CONCLUSIONS: Congenital toxoplasmosis resulting reactivation of infection during pregnancy in the studied group leads us to believe that it is a public health problem, especially in our population, in which seroprevalence of T. gondii infections is high. These findings also suggest that special attention is necessary during pregnancy, because the serologic diagnosis may not be indicative of toxoplasmosis reactivation.