Abstract Objective To perform a systematic review and meta-analysis of studies on maternal, fetal, and neonatal outcomes of women with singleton pregnancies, after spontaneous conception, and with the diagnosis of amniotic sludge before 37 weeks of gestational age. Data Sources We conducted a search on the PubMed, Cochrane, Bireme, and Theses databases until June 2022. Selection of Studies Using the keywords intra-amniotic sludge or fluid sludge or echogenic particles, we found 263 articles, 132 of which were duplicates, and 70 were discarded because they did not meet the inclusion criteria. Data Collection The articles retrieved were analyzed by 2 reviewers; 61 were selected for full-text analysis, 18 were included for a qualitative analysis, and 14, for a quantitative analysis. Data Synthesis Among the maternal outcomes analyzed, there was an increased risk of preterm labor (95% confidence interval [95%CI]: 1.45–2.03), premature rupture of ovular membranes (95%CI: 1.99–3.79), and clinical (95%CI: 1.41–6.19) and histological chorioamnionitis (95%CI: 1.75–3.12). Regarding the fetal outcomes, there was a significant increase in the risk of morbidity (95%CI: 1.80–3.17), mortality (95%CI: 1.14–18.57), admission to the Neonatal Intensive Care Unit (NICU; 95%CI: 1.17–1.95), and neonatal sepsis (95%CI: 2.29–7.55). Conclusion The results of the present study indicate that the presence of amniotic sludge is a risk marker for preterm delivery. Despite the heterogeneity of the studies analyzed, even in patients with other risk factors for prematurity, such as short cervix and previous preterm delivery, the presence of amniotic sludge increases the risk of premature labor. Moreover, antibiotic therapy seems to be a treatment for amniotic sludge, and it may prolong pregnancy. metaanalysis meta analysis pregnancies conception 3 age PubMed Cochrane Bireme 2022 intraamniotic intra particles 26 13 duplicates 7 criteria reviewers 6 fulltext full text 1 14 95% 95 (95 95%CI 95CI CI [95%CI] 1.45–2.03, 145203 1.45–2.03 , 45 03 1.45–2.03) (95%CI 1.99–3.79, 199379 1.99–3.79 99 79 1.99–3.79) 1.41–6.19 141619 41 19 1.75–3.12. 175312 1.75–3.12 . 75 12 1.75–3.12) 1.80–3.17, 180317 1.80–3.17 80 17 1.80–3.17) 1.14–18.57, 1141857 1.14–18.57 57 1.14–18.57) NICU (NICU 1.17–1.95, 117195 1.17–1.95 1.17–1.95) 2.29–7.55. 229755 2.29–7.55 29 55 2.29–7.55) delivery prematurity Moreover pregnancy 202 9 (9 [95%CI 14520 1.45–2.0 4 0 19937 1.99–3.7 1.41–6.1 14161 17531 1.75–3.1 18031 1.80–3.1 8 114185 1.14–18.5 5 11719 1.17–1.9 22975 2.29–7.5 20 ( 1452 1.45–2. 1993 1.99–3. 1.41–6. 1416 1753 1.75–3. 1803 1.80–3. 11418 1.14–18. 1171 1.17–1. 2297 2.29–7. 145 1.45–2 199 1.99–3 1.41–6 141 175 1.75–3 180 1.80–3 1141 1.14–18 117 1.17–1 229 2.29–7 1.45– 1.99– 1.41– 1.75– 1.80– 114 1.14–1 11 1.17– 22 2.29– 1.45 1.99 1.41 1.75 1.80 1.14– 1.17 2.29 1.4 1.9 1.7 1.8 1.14 1.1 2.2 1. 2.

Resumo Objetivo Realizar revisão sistemática e metanálise de estudos que avaliaram os desfechos maternos, fetais e neonatais em gestantes de gravidez única, após concepção espontânea, e com o diagnóstico de sludge amniótico antes de 37 semanas de idade gestacional. Fontes dos dados Realizou-se uma pesquisa nas bases de dados PubMed, Cochrane, Bireme e Teses até junho de 2022. Seleção dos estudos Usando as palavras-chave intra-amniotic sludge ou fluid sludge ou echogenic particles, foram encontrados 263 artigos, 132 dos quais eram duplicatas, e 70 foram descartados por não corresponderem aos critérios de inclusão. Coleta de dados Os artigos encontrados foram analisados por 2 revisores; 61 foram selecionados para análise de texto completo, 18 foram incluídos em uma análise qualitativa e 14, em uma análise quantitativa. Síntese dos dados Entre os desfechos maternos analisados, houve aumento do risco de trabalho de parto prematuro (intervalo de confiança de 95% [IC95%]: 1.45–2.03), rotura prematura de membranas ovulares (IC95%: 1.99–3.79), e corioamnionite clínica (IC95%: 1.41–6.19) e histológica (IC95%: 1.75–3.12). Em relação aos desfechos fetais, houve aumento significativo do risco de morbidade (IC95%: 1.80–3.17), mortalidade (IC95%: 1.14–18.57), admissão em Unidade de Tratamento Intensivo (UTI) neonatal (IC95%: 1.17–1.95) e sepse neonatal (IC95%: 2.29–7.55). Conclusão Os resultados do presente estudo indicam que a presença de sludge amniótico é um marcador de risco para parto prematuro. Apesar da heterogeneidade dos estudos analisados, até mesmo em pacientes com outros fatores de risco para prematuridade, como colo curto e trabalho de parto prematuro anterior, a presença de sludge amniótico aumenta o risco de trabalho de parto prematuro na gestação. Além do mais, a antibioticoterapia parece ser um tratamento para o sludge amniótico, e pode ser capaz de prolongar a gravidez. única espontânea 3 gestacional Realizouse Realizou se PubMed Cochrane 2022 palavraschave palavras chave intraamniotic intra amniotic particles 26 13 duplicatas 7 inclusão revisores 6 completo 1 14 quantitativa intervalo 95 IC95% IC95 IC [IC95%] 1.45–2.03, 145203 1.45–2.03 , 45 03 1.45–2.03) (IC95% 1.99–3.79, 199379 1.99–3.79 99 79 1.99–3.79) 1.41–6.19 141619 41 19 1.75–3.12. 175312 1.75–3.12 . 75 12 1.75–3.12) 1.80–3.17, 180317 1.80–3.17 80 17 1.80–3.17) 1.14–18.57, 1141857 1.14–18.57 57 1.14–18.57) UTI (UTI 1.17–1.95 117195 2.29–7.55. 229755 2.29–7.55 29 55 2.29–7.55) prematuridade anterior gestação mais 202 9 IC9 [IC95% 14520 1.45–2.0 4 0 (IC95 19937 1.99–3.7 1.41–6.1 14161 17531 1.75–3.1 18031 1.80–3.1 8 114185 1.14–18.5 5 1.17–1.9 11719 22975 2.29–7.5 20 [IC95 1452 1.45–2. (IC9 1993 1.99–3. 1.41–6. 1416 1753 1.75–3. 1803 1.80–3. 11418 1.14–18. 1.17–1. 1171 2297 2.29–7. [IC9 145 1.45–2 (IC 199 1.99–3 1.41–6 141 175 1.75–3 180 1.80–3 1141 1.14–18 1.17–1 117 229 2.29–7 [IC 1.45– 1.99– 1.41– 1.75– 1.80– 114 1.14–1 1.17– 11 22 2.29– 1.45 1.99 1.41 1.75 1.80 1.14– 1.17 2.29 1.4 1.9 1.7 1.8 1.14 1.1 2.2 1. 2.

ABSTRACT Objective To perform a systematic review and meta-analysis of randomized clinical trials that compared the use of antibiotics versus placebo in premature rupture of membranes preterm and evaluated maternal, fetal and neonatal outcomes in pregnant women with premature rupture of ovular membranes at a gestational age between 24 and 37 weeks. Methods A search was conducted using keywords in PubMed, Cochrane, Biblioteca Virtual em Saúde and Biblioteca Digital de Teses e Dissertações da USP between August 2018 and December 2021. A total of 926 articles were found. Those included were randomized clinical trials that compared the use of antibiotics versus placebo in the premature rupture of preterm membranes. Articles referring to antibiotics only for streptococcus agalactiae prophylaxis were excluded. The retrieved articles were independently and blindly analyzed by two reviewers. A total of 24 manuscripts met the inclusion criteria and 21 articles were included for quantitative analysis. Results Among the maternal outcomes analyzed, there was a prolongation of the latency period that was ≥7 days. In addition, we observed a reduction in chorioamnionitis in the group of pregnant women who used antibiotics. As for endometritis and other maternal outcomes, there was no statistically significant difference between the groups. Regarding fetal outcomes, antibiotic prophylaxis worked as a protective factor for neonatal sepsis. Necrotizing enterocolitis and respiratory distress syndrome showed no statistically significant differences. Conclusion The study showed positive results in relation to antibiotic prophylaxis to prolong the latency period, new randomized clinical trials are needed to ensure its beneficial effect. Prospero database registration (www.crd.york.ac.uk/prospero) under number CRD42020155315.

RESUMO Objetivo Pesquisar os dados epidemiológicos da hipertensão arterial em gestantes, bem como identificar seus possíveis eventos associados. Métodos A coleta de dados foi realizada no ambulatório do pré-natal de alto risco e na enfermaria da maternidade em hospital público da cidade de São Paulo, nos períodos matutino e vespertino, de outubro de 2015 a julho de 2016. Foi aplicado um questionário com 22 perguntas elaborado pelos pesquisadores. A margem de erro foi de 5% e o nível de confiança, de 95%. Para o cálculo, foram usados o teste de igualdade de duas proporções, a correlação de Pearson e o teste de ANOVA. Resultados Dentre as entrevistadas, 43% tinham hipertensão crônica, 33,3% se apresentaram com até 20 semanas de gestação, 23,7% se apresentaram após a 20ª semana da gestação, 62,3% tinham idade entre 18 e 35 anos, 78,1% tinham antecedente familiar com hipertensão arterial, 11,4% com idade entre 36 a 45 anos estavam na primeira gestação, e 26,3% com a mesma idade estavam a partir da segunda gestação. Dentre as afecções associadas, prevaleceu o diabetes com 50%; 22,2% se tratavam de obesidade, e dos alimentos mais escolhidos para consumo entre as gestantes, 47,5% possuíam alto teor energético (processados/ultraprocessados). Conclusão Após análise epidemiológica no resultado da prevalência da hipertensão arterial, foram encontradas gestantes com hipertensão arterial crônica, hipertensão arterial preexistente descoberta durante a gestação e doença hipertensiva específica da gestação. Em relação aos possíveis fatores associados à hipertensão arterial, foram encontrados: idade mais elevada, antecedentes familiares de hipertensão, preexistência de hipertensão, gestações tardias, diabetes, obesidade e frequente consumo de alimentos processados/ultraprocessados.

ABSTRACT Objective To investigate the epidemiological data of hypertension in pregnant women, as well as to identify its possible associated events. Methods Data collection was performed at the high-risk prenatal outpatient clinic and in the maternity ward at a public hospital in the São Paulo city, during the morning and afternoon periods, from October 2015 to July 2016. A questionnaire with 22 questions prepared by the researchers was used. The margin of error was 5% and the confidence level was 95%. For the calculation, the two-proportion equality, Pearson correlation and ANOVA tests were used. Results Among the interviewees, 43% had chronic hypertension, 33.3% presented with up to 20 weeks of gestation, 23.7% presented after the 20th week of gestation, 62.3% were between 18 and 35 years of age, 78.1% had a family history of hypertension, and among those aged 36 to 45 years, 11.4% were in the first gestation, and 26.3% in the second gestation. Considering the associated conditions, diabetes prevailed with 50%; obesity with 22.2%, and the most selected foods for consumption among pregnant women, 47.5% had high energy content (processed/ultraprocessed). Conclusion After an epidemiological analysis of the prevalence of hypertension, pregnant women with chronic hypertension, preexisting hypertension diagnosed during pregnancy, and hypertensive disease of pregnancy were identified. Regarding the possible factors associated with arterial hypertension, higher age, family history of hypertension, preexistence of hypertension, late pregnancies, diabetes, obesity and frequent consumption of processed/ultraprocessed foods were found.