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Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(4):325-328
DOI 10.1590/S0100-72032004000400010
OBJECTIVE: to evaluate the sensitivity and specificity of a rapid antibody HIV test (DetermineTM - Abott) for women in labor between August 1, 2001, and October 5, 2002. METHODS: all parturient women who had not been tested for the detection of HIV during pregnancy or had the result of an HIV test not available at admission were included in the present study. Blood samples were collected at the moment of admission, and the rapid test was carried out and compared with the gold standard (ELISA and Western blot). RESULTS: in 298 pregnant women assessed, the rapid test was positive in 16 (5.3%), and the results were confirmed by ELISA and Western blot in 12 cases (4%). All negative results were confirmed by the ELISA and Western blot tests. CONCLUSIONS: the test presented 100% sensitivity, 98% specificity, 75% positive predictive value, and 100% negative predictive value. These data show the importance of the rapid test for the detection of HIV infection in emergencies, such as imminent delivery of non-previously tested pregnant women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(4):325-328
DOI 10.1590/S0100-72032004000400010
OBJECTIVE: to evaluate the sensitivity and specificity of a rapid antibody HIV test (DetermineTM - Abott) for women in labor between August 1, 2001, and October 5, 2002. METHODS: all parturient women who had not been tested for the detection of HIV during pregnancy or had the result of an HIV test not available at admission were included in the present study. Blood samples were collected at the moment of admission, and the rapid test was carried out and compared with the gold standard (ELISA and Western blot). RESULTS: in 298 pregnant women assessed, the rapid test was positive in 16 (5.3%), and the results were confirmed by ELISA and Western blot in 12 cases (4%). All negative results were confirmed by the ELISA and Western blot tests. CONCLUSIONS: the test presented 100% sensitivity, 98% specificity, 75% positive predictive value, and 100% negative predictive value. These data show the importance of the rapid test for the detection of HIV infection in emergencies, such as imminent delivery of non-previously tested pregnant women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(6):325-332
To determine the efficacy of Uterine Artery Embolization in patients with bleeding acquired uterine arteriovenous malformations (AVMs).
A prospective review of all patients who underwent Uterine Artery Embolization at our institution between July 2015 and April 2022 was performed. 225 patients were diagnosed with a uterine vascular malformation on doppler and corresponding MRI imaging. All patients underwent transcatheter embolization of the uterine arteries. Embolic agents in the 375 procedures included Histoacryl glue only (n = 326), polyvinyl alcohol (PVA) particles and Histoacryl glue (n = 29), PVA particles (n = 5), Gelfoam (n = 5), coils (n = 4), PVA particles and coils (n = 3), Histoacryl glue and Gelfoam (n = 2), and Histoacryl glue and coils (n = 1).
A total of 375 embolization procedures were performed in 225 patients. 90 patients required repeat embolization for recurrence of bleeding. The technical success rate of embolization was 100%. The clinical success rate was 92%: bleeding was controlled in 222 of 225 patients and three patients underwent a hysterectomy. 60 of the 225 patients had uneventful intrauterine pregnancies carried to term. The 210 patients who underwent successful embolization had no recurrence of bleeding at a median follow-up of 53 months (range, 5-122 months) after treatment. 15 patients were eventually lost to follow-up. One minor complication (0.4%) of non-flow-limiting dissection of the internal iliac artery occurred.
Uterine Artery Embolization is a safe, effective, minimally invasive method to treat uterine AVMs with long-term efficacy, which can provide the preservation of fertility.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(6):325-332
To determine the efficacy of Uterine Artery Embolization in patients with bleeding acquired uterine arteriovenous malformations (AVMs).
A prospective review of all patients who underwent Uterine Artery Embolization at our institution between July 2015 and April 2022 was performed. 225 patients were diagnosed with a uterine vascular malformation on doppler and corresponding MRI imaging. All patients underwent transcatheter embolization of the uterine arteries. Embolic agents in the 375 procedures included Histoacryl glue only (n = 326), polyvinyl alcohol (PVA) particles and Histoacryl glue (n = 29), PVA particles (n = 5), Gelfoam (n = 5), coils (n = 4), PVA particles and coils (n = 3), Histoacryl glue and Gelfoam (n = 2), and Histoacryl glue and coils (n = 1).
A total of 375 embolization procedures were performed in 225 patients. 90 patients required repeat embolization for recurrence of bleeding. The technical success rate of embolization was 100%. The clinical success rate was 92%: bleeding was controlled in 222 of 225 patients and three patients underwent a hysterectomy. 60 of the 225 patients had uneventful intrauterine pregnancies carried to term. The 210 patients who underwent successful embolization had no recurrence of bleeding at a median follow-up of 53 months (range, 5-122 months) after treatment. 15 patients were eventually lost to follow-up. One minor complication (0.4%) of non-flow-limiting dissection of the internal iliac artery occurred.
Uterine Artery Embolization is a safe, effective, minimally invasive method to treat uterine AVMs with long-term efficacy, which can provide the preservation of fertility.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(4):325-326
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(4):325-326
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(7):326-334
DOI 10.1590/S0100-72032009000700002
PURPOSE: to analyze the association of the mother's age, the perinatal outcome and the delivery route. METHODS: information about all the patients attended at the Service of Obstetrics and Gynecology of a tertiary university hospital in Maranhão, from July to December 2006, was analyzed. Patients have been allocated in three groups: adolescents (10 to 19 years old), adults (20 to 34 years old), and aged women (>35 years old). Variables studied were: skin color, schooling, marital status, family income, parity, number of appointments during pre-natal care, gestational age at the onset of pre-natal care, delivery route, Apgar index at the fifth minute and birth weight. Data were processed by the Epi-info program, version 3.4.1, and the association among the variables was analyzed by the Odds Ratio (OR) or the cross product ratio, with confidence intervals (CI) of 95%. The significance level was 0.05. RESULTS: among 2,196 patients, 25% of deliveries occurred in adolescents, 69% in adults and 6% in aged women. Among the adolescents, there was higher risk of prematurity (OR=1.46; CI95%=1.14-1.88), and low birth weight (OR=1.47; CI95%=1.13- 1.90), higher incidence of normal delivery as compared to the other groups (65.2%), besides the association with late onset of pre-natal care (OR=1.86; CI95%=1.43-2.43), lower number of appointments (OR=2.03; CI95%=1.57-2.63), and use of abortive procedures at the onset of gestation (OR=2.34; CI95%=1.38-3.98). Among aged women, there was strong association with diabetes mellitus (OR=9.00; CI95%=3.18-25.19), pre-eclampsia (OR=4.38; CI95%=3.02-6.34), premature membrane rupture (OR=5.81; CI95%=3.08-10.89), besides a higher chance of presenting Apgar index lower than seven at the fifth minute (OR=2.90; CI95%=1.37-6.01), and higher ratio of cesarean section (60.3%). CONCLUSIONS: pregnancy in adolescence is associated to late onset of pre-natal care and few appointments along it, use of abortive procedures at the onset of gestation, low schooling, no mates, low birth weight, prematurity, and lower incidence of cephalo pelvic disproportion and pre-eclampsia. Among aged pregnant women, there was association with diabetes, pre-eclampsia, premature membrane rupture, Apgar index lower than seven at the fifth minute and higher ratio of cesarean section.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(7):326-334
DOI 10.1590/S0100-72032009000700002
PURPOSE: to analyze the association of the mother's age, the perinatal outcome and the delivery route. METHODS: information about all the patients attended at the Service of Obstetrics and Gynecology of a tertiary university hospital in Maranhão, from July to December 2006, was analyzed. Patients have been allocated in three groups: adolescents (10 to 19 years old), adults (20 to 34 years old), and aged women (>35 years old). Variables studied were: skin color, schooling, marital status, family income, parity, number of appointments during pre-natal care, gestational age at the onset of pre-natal care, delivery route, Apgar index at the fifth minute and birth weight. Data were processed by the Epi-info program, version 3.4.1, and the association among the variables was analyzed by the Odds Ratio (OR) or the cross product ratio, with confidence intervals (CI) of 95%. The significance level was 0.05. RESULTS: among 2,196 patients, 25% of deliveries occurred in adolescents, 69% in adults and 6% in aged women. Among the adolescents, there was higher risk of prematurity (OR=1.46; CI95%=1.14-1.88), and low birth weight (OR=1.47; CI95%=1.13- 1.90), higher incidence of normal delivery as compared to the other groups (65.2%), besides the association with late onset of pre-natal care (OR=1.86; CI95%=1.43-2.43), lower number of appointments (OR=2.03; CI95%=1.57-2.63), and use of abortive procedures at the onset of gestation (OR=2.34; CI95%=1.38-3.98). Among aged women, there was strong association with diabetes mellitus (OR=9.00; CI95%=3.18-25.19), pre-eclampsia (OR=4.38; CI95%=3.02-6.34), premature membrane rupture (OR=5.81; CI95%=3.08-10.89), besides a higher chance of presenting Apgar index lower than seven at the fifth minute (OR=2.90; CI95%=1.37-6.01), and higher ratio of cesarean section (60.3%). CONCLUSIONS: pregnancy in adolescence is associated to late onset of pre-natal care and few appointments along it, use of abortive procedures at the onset of gestation, low schooling, no mates, low birth weight, prematurity, and lower incidence of cephalo pelvic disproportion and pre-eclampsia. Among aged pregnant women, there was association with diabetes, pre-eclampsia, premature membrane rupture, Apgar index lower than seven at the fifth minute and higher ratio of cesarean section.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(7):327-333
DOI 10.1590/S0100-72032010000700004
PURPOSE: to evaluate the clinical and epidemiological risk factors for endometrial cancer in postmenopausal women with endometrial polyps, as well as the genetic polymorphism of the progesterone receptor (PROGINS). METHODS: a case-control study was designed with 160 postmenopausal women with endometrial polyps, compared to a normal Control Group of 400 postmenopausal women. The genotyping of PROGINS polymorphism was determined by the polymerase chain reaction. Clinical and epidemiological data were compared between benign endometrial polyps and 118 of the control subjects. Variables were also compared with regard to benign and malignant endometrial polyps. RESULTS: comparison of the epidemiological variables between groups showed a significant difference for age, ethnicity, time since menopause, parity, tamoxifen use, hypertension and breast cancer, all of them more prevalent in the polyp group. After adjustment for age, statistical significance remained only for parity (OR=1.1), hypertension (OR=2.2) and breast cancer (OR=14.4). There were six cases of malignant polyps (3.7%). The frequency of bleeding was 23.4% for benign polyps and 100% for malignant polyps, with large polyps being detected in 54.6% of the benign cases and in 100 of the malignnat ones. The frequency of arterial hypertension was 54.5% for benign polyps and 83.3% for the malignant ones. The frequency of PROGINS T1/T1, T1/T2 and T2/T2 polymorphism was 79.9%, 19.5% and 0.6%, respectively, for the polyp group, and 78.8%, 20.8% and 0.5% for the Control Group. CONCLUSIONS: elderly age, hypertension, and breast cancer were significantly associated with endometrial polyps. The presence of PROGINS polymorphism was not significantly associated with endometrial polyps. The incidence of malignant polyps was low and strongly associated with bleeding, large-sized polyp and arterial hypertension.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(7):327-333
DOI 10.1590/S0100-72032010000700004
PURPOSE: to evaluate the clinical and epidemiological risk factors for endometrial cancer in postmenopausal women with endometrial polyps, as well as the genetic polymorphism of the progesterone receptor (PROGINS). METHODS: a case-control study was designed with 160 postmenopausal women with endometrial polyps, compared to a normal Control Group of 400 postmenopausal women. The genotyping of PROGINS polymorphism was determined by the polymerase chain reaction. Clinical and epidemiological data were compared between benign endometrial polyps and 118 of the control subjects. Variables were also compared with regard to benign and malignant endometrial polyps. RESULTS: comparison of the epidemiological variables between groups showed a significant difference for age, ethnicity, time since menopause, parity, tamoxifen use, hypertension and breast cancer, all of them more prevalent in the polyp group. After adjustment for age, statistical significance remained only for parity (OR=1.1), hypertension (OR=2.2) and breast cancer (OR=14.4). There were six cases of malignant polyps (3.7%). The frequency of bleeding was 23.4% for benign polyps and 100% for malignant polyps, with large polyps being detected in 54.6% of the benign cases and in 100 of the malignnat ones. The frequency of arterial hypertension was 54.5% for benign polyps and 83.3% for the malignant ones. The frequency of PROGINS T1/T1, T1/T2 and T2/T2 polymorphism was 79.9%, 19.5% and 0.6%, respectively, for the polyp group, and 78.8%, 20.8% and 0.5% for the Control Group. CONCLUSIONS: elderly age, hypertension, and breast cancer were significantly associated with endometrial polyps. The presence of PROGINS polymorphism was not significantly associated with endometrial polyps. The incidence of malignant polyps was low and strongly associated with bleeding, large-sized polyp and arterial hypertension.
, , , , Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(4):327-335
, , , , Determine the predictive criteria for success in inducing labor for live fetuses using misoprostol in pregnant women. Secondarily, the objective is to determine the rates of vaginal or cesarean delivery, duration of induction, interval of administration of misoprostol, the main causes of induction of labor and indication for operative delivery.
Medical records of 873 pregnant women admitted for cervical maturation from January 2017 to December 2018 were reviewed in a descriptive observational study of retrospective analysis, considering the following response variables: age, parity, Bishop Index, doses of misoprostol, labor induction time. Logistic regression models were used to predict success with misoprostol in non-operative deliveries.
Of the 873 patients evaluated, 72% evolved with vaginal delivery, 23% of the cases were cesarean, 5% forceps or vacuum-extractor. For non-operative delivery the predictive variables at admission were age, parity, gestational age and dilation. During hospitalization, fewer vaginal touches,amniotomy or amniorrhexis with clear fluid lead to a shorter induction time and a greater chance of non-operative delivery. False positives and false negatives of the model were always below 50% and correct answers above 65%.
At admission, age less than 24 years, previous normal births, lower the gestational age and greater the dilation, were predictive of greater probability of nonoperative delivery. During hospitalization, the less vaginal touches and occurrence of amniotomy/amniorrhexis with clear liquid indicate shorter induction time. Future studies with a prospective design and analysis of other factors are necessary to assess the replicability, generalization of these findings.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(4):327-335
, , , , Determine the predictive criteria for success in inducing labor for live fetuses using misoprostol in pregnant women. Secondarily, the objective is to determine the rates of vaginal or cesarean delivery, duration of induction, interval of administration of misoprostol, the main causes of induction of labor and indication for operative delivery.
Medical records of 873 pregnant women admitted for cervical maturation from January 2017 to December 2018 were reviewed in a descriptive observational study of retrospective analysis, considering the following response variables: age, parity, Bishop Index, doses of misoprostol, labor induction time. Logistic regression models were used to predict success with misoprostol in non-operative deliveries.
Of the 873 patients evaluated, 72% evolved with vaginal delivery, 23% of the cases were cesarean, 5% forceps or vacuum-extractor. For non-operative delivery the predictive variables at admission were age, parity, gestational age and dilation. During hospitalization, fewer vaginal touches,amniotomy or amniorrhexis with clear fluid lead to a shorter induction time and a greater chance of non-operative delivery. False positives and false negatives of the model were always below 50% and correct answers above 65%.
At admission, age less than 24 years, previous normal births, lower the gestational age and greater the dilation, were predictive of greater probability of nonoperative delivery. During hospitalization, the less vaginal touches and occurrence of amniotomy/amniorrhexis with clear liquid indicate shorter induction time. Future studies with a prospective design and analysis of other factors are necessary to assess the replicability, generalization of these findings.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):327-331
DOI 10.1590/S0100-72031999000600005
Purpose: the authors modified the original Ayre spatula aiming at optimizing endocervical collection. The study verified if the capacity of the modified spatula in collecting endocervical cells is similar to that obtained by the combination brush-Ayre spatula and better than the Ayre spatula alone. Methods: a diagnostic and single-blind simple study was performed. The patients were randomly assigned to one of three collection groups (Ayre spatula, combination of brush-Ayre spatula and modified spatula). After excluding data of 25 patients, 276 smears were evaluated with attention to the presence of squamous, metaplastic, and columnar endocervical cells and their combination. In order to compare methods, the chi² test with corrected Yates values and the exact Fisher test were used. Results: the combination brush-Ayre spatula presented the best performance in the production of columnar endocervical cells. When compared to the combination of brush-Ayre spatula, the modified spatula produced less bleeding in the smears (chi² = 7.98; p = 0.004) and it was not statistically inferior in obtaining metaplastic cells (chi² = 2.97; p = 0.08). When compared to the Ayre spatula, it was statistically superior in obtaining columnar endocervical cells (chi² = 21.37; p = 0.000004) and presented a greater percentage of smears presenting squamous cells accompanied by metaplastic and/or columnar endocervical cells (chi² = 10.97; p = 0.0009). Conclusions: it was concluded that the modified spatula improved the quality of the sample obtained with the Ayre spatula alone, being able to be used in populations where the use of the brush was impossible.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(6):327-331
DOI 10.1590/S0100-72031999000600005
Purpose: the authors modified the original Ayre spatula aiming at optimizing endocervical collection. The study verified if the capacity of the modified spatula in collecting endocervical cells is similar to that obtained by the combination brush-Ayre spatula and better than the Ayre spatula alone. Methods: a diagnostic and single-blind simple study was performed. The patients were randomly assigned to one of three collection groups (Ayre spatula, combination of brush-Ayre spatula and modified spatula). After excluding data of 25 patients, 276 smears were evaluated with attention to the presence of squamous, metaplastic, and columnar endocervical cells and their combination. In order to compare methods, the chi² test with corrected Yates values and the exact Fisher test were used. Results: the combination brush-Ayre spatula presented the best performance in the production of columnar endocervical cells. When compared to the combination of brush-Ayre spatula, the modified spatula produced less bleeding in the smears (chi² = 7.98; p = 0.004) and it was not statistically inferior in obtaining metaplastic cells (chi² = 2.97; p = 0.08). When compared to the Ayre spatula, it was statistically superior in obtaining columnar endocervical cells (chi² = 21.37; p = 0.000004) and presented a greater percentage of smears presenting squamous cells accompanied by metaplastic and/or columnar endocervical cells (chi² = 10.97; p = 0.0009). Conclusions: it was concluded that the modified spatula improved the quality of the sample obtained with the Ayre spatula alone, being able to be used in populations where the use of the brush was impossible.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(11):328-333
DOI 10.1590/S0100-72032011001100002
PURPOSE: to determine the prevalence of Chlamydia and gonorrhea in a sample of women from Curitiba. METHODS: this was a cross-sectional study with a sample of sexually active non-pregnant women aged between 16 and 23 years-old, with an intact uterus, with up to four sexual partners, without evidence of fever or purulent cervicitis, submitted to pelvic examination and PCR-based urine- testing for Chlamydia and gonorrhea. Exclusion criteria included: vaccination for HPV, vaccination history for the past 21 days, previous abnormal cytology, history of genital warts, splenectomy, immune disorders, and use of immunosuppressive drugs. An interview regarding sociodemographic and obstetric data and gynecological risk behavior for sexual transmitted diseases was applied. For statistical analysis, we used the c2 or Fisher’s exact test to assess the association between variables. RESULTS: the prevalence of Chlamydia and gonorrhea infection in the study group was 10.7 and 1.5%, respectively, and the rate of coinfection was 0.9%. No correlation was found between the age range of the volunteers, the onset of sexual activity, the number of sexual partners and of new sexual partners in the last six months, and the presence of Chlamydia or gonorrhea. In women who had vaginal discharge or ectropion, the prevalence of Chlamydia infection was two times higher than in those without such signs. CONCLUSIONS: the results of this study were similar to national studies using PCR in urine samples for the detection of Chlamydia and gonorrhea in samples of non-pregnant women of the same age groups and with the same background. Since the volunteers with more than four sexual partners and those who had purulent endocervicitis were excluded, it is believed that the prevalence of Chlamydia and gonorrhea infection could have been greater in this population.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(11):328-333
DOI 10.1590/S0100-72032011001100002
PURPOSE: to determine the prevalence of Chlamydia and gonorrhea in a sample of women from Curitiba. METHODS: this was a cross-sectional study with a sample of sexually active non-pregnant women aged between 16 and 23 years-old, with an intact uterus, with up to four sexual partners, without evidence of fever or purulent cervicitis, submitted to pelvic examination and PCR-based urine- testing for Chlamydia and gonorrhea. Exclusion criteria included: vaccination for HPV, vaccination history for the past 21 days, previous abnormal cytology, history of genital warts, splenectomy, immune disorders, and use of immunosuppressive drugs. An interview regarding sociodemographic and obstetric data and gynecological risk behavior for sexual transmitted diseases was applied. For statistical analysis, we used the c2 or Fisher’s exact test to assess the association between variables. RESULTS: the prevalence of Chlamydia and gonorrhea infection in the study group was 10.7 and 1.5%, respectively, and the rate of coinfection was 0.9%. No correlation was found between the age range of the volunteers, the onset of sexual activity, the number of sexual partners and of new sexual partners in the last six months, and the presence of Chlamydia or gonorrhea. In women who had vaginal discharge or ectropion, the prevalence of Chlamydia infection was two times higher than in those without such signs. CONCLUSIONS: the results of this study were similar to national studies using PCR in urine samples for the detection of Chlamydia and gonorrhea in samples of non-pregnant women of the same age groups and with the same background. Since the volunteers with more than four sexual partners and those who had purulent endocervicitis were excluded, it is believed that the prevalence of Chlamydia and gonorrhea infection could have been greater in this population.