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Rev Bras Ginecol Obstet. 2000;22(1):27-32
DOI 10.1590/S0100-72032000000100005
Purpose: to identify and quantify the underreporting of maternal mortality, from death certificates (DC) in Campinas, São Paulo, from 1992 to 1994. Methods: a total of 216 DC whose causes of death were maternal (declared and/or presumed) were selected among the 1032 DC of 10 to 49-year-old women. A complementary investigation was performed on hospital records, at the death verifying units, and in households. Results: eight additional maternal deaths were identified among the 204 DC with presumed maternal death. This corresponded to an underreporting rate of 40% or to a correction factor of 1.67 for the official MMR. The first cause of underreporting was abortion (71.5% or 05/07) and indirect maternal deaths represented the second cause (66.6% or 02/03). Conclusions: the death certificate cannot be considered the only source to identify maternal death. Complementary investigation of the presumable causes of maternal death should be performed. Legislation, social and religious factors might influence the underreporting of abortion as the cause of maternal death.
Summary
Rev Bras Ginecol Obstet. 2000;22(1):27-32
DOI 10.1590/S0100-72032000000100005
Purpose: to identify and quantify the underreporting of maternal mortality, from death certificates (DC) in Campinas, São Paulo, from 1992 to 1994. Methods: a total of 216 DC whose causes of death were maternal (declared and/or presumed) were selected among the 1032 DC of 10 to 49-year-old women. A complementary investigation was performed on hospital records, at the death verifying units, and in households. Results: eight additional maternal deaths were identified among the 204 DC with presumed maternal death. This corresponded to an underreporting rate of 40% or to a correction factor of 1.67 for the official MMR. The first cause of underreporting was abortion (71.5% or 05/07) and indirect maternal deaths represented the second cause (66.6% or 02/03). Conclusions: the death certificate cannot be considered the only source to identify maternal death. Complementary investigation of the presumable causes of maternal death should be performed. Legislation, social and religious factors might influence the underreporting of abortion as the cause of maternal death.
Summary
Rev Bras Ginecol Obstet. 2021;43(4):291-296
To evaluate whether continuation rates with the 52-mg levonorgestrelreleasing intrauterine system (LNG-IUS) up to 5 years after placement differed between women using the method exclusively for contraception and those using the device for medical reasons alone.
A retrospective cohort study was conducted in a family planning clinic with 5,034 LNG-IUS users: 4,287 using the method exclusively for contraception and 747 for medical reasons alone. The continuation rate at 1 to 5 years of use was calculated by life table analysis.
Initially, the continuation rate was significantly higher in the contraception group: 85.8 versus 83.4 and 77.4 versus 76.0 per 100 women-years in the 1st and 2nd years of use, respectively. There were more discontinuations due to bleeding/spotting in the medical reasons group in the first two years. The discontinuation rate according to reason for use was not significantly different from the third to the fifth year of use. No women discontinued due to amenorrhea in either group.
The continuation rate was significantly higher in the contraception group in the first two years of use. Amenorrhea was not a reason for discontinuation in either group, suggesting that counselling in this respect was adequate. Nevertheless, counselling could perhaps have been better with regards to the expected long period of bleeding and spotting in the first two years after placement.
Summary
Rev Bras Ginecol Obstet. 2021;43(4):291-296
To evaluate whether continuation rates with the 52-mg levonorgestrelreleasing intrauterine system (LNG-IUS) up to 5 years after placement differed between women using the method exclusively for contraception and those using the device for medical reasons alone.
A retrospective cohort study was conducted in a family planning clinic with 5,034 LNG-IUS users: 4,287 using the method exclusively for contraception and 747 for medical reasons alone. The continuation rate at 1 to 5 years of use was calculated by life table analysis.
Initially, the continuation rate was significantly higher in the contraception group: 85.8 versus 83.4 and 77.4 versus 76.0 per 100 women-years in the 1st and 2nd years of use, respectively. There were more discontinuations due to bleeding/spotting in the medical reasons group in the first two years. The discontinuation rate according to reason for use was not significantly different from the third to the fifth year of use. No women discontinued due to amenorrhea in either group.
The continuation rate was significantly higher in the contraception group in the first two years of use. Amenorrhea was not a reason for discontinuation in either group, suggesting that counselling in this respect was adequate. Nevertheless, counselling could perhaps have been better with regards to the expected long period of bleeding and spotting in the first two years after placement.
Summary
Rev Bras Ginecol Obstet. 2003;25(5):309-316
DOI 10.1590/S0100-72032003000500002
PURPOSE: to determine the prevalence of domestic physical violence among women who delivered at a tertiary center in the Northeast of Brazil, to study the main risk factors associated with domestic violence, and to determine perinatal outcome. METHODS: a cross-sectional study was conducted, enrolling 420 women who delivered at a tertiary center in Recife (Brazil) with fetuses weighing more than 500 g. They were submitted to interviews with open and closed questions. The prevalence of domestic physical violence was determined. Statistical analysis was performed using c² and Fisher's exact tests at a 5% level of significance. The prevalence ratio was determined as measurement of relative risk of violence. Multiple logistic regression analysis was performed and the adjusted risk was calculated. RESULTS: the prevalence of domestic physical violence was 13.1% (95% CI = 10.1-16.6) and 7.4% (95% CI = 5.2-10.2) before and during pregnancy, respectively. The pattern of violence has changed during pregnancy: stopped in 43.6%, was reduced in 27.3% and increased in 11% of the victims. After multivariate analysis the variables that persisted strongly associated with violence were low female educational level, history of violence in the women´s family, partner's use of alcohol and unemployment. Perinatal outcome was studied and a significantly higher frequency of neonatal death was observed among victims of domestic violence. CONCLUSIONS: a high prevalence of domestic physical violence was observed (about 13%) in women who delivered at a tertiary center in Northeast of Brazil. The main risk factors were low educational level and previous familiar history of violence in the women's family, alcohol use by and unemployment of their partners. Neonatal mortality was increased in victims of violence.
Summary
Rev Bras Ginecol Obstet. 2003;25(5):309-316
DOI 10.1590/S0100-72032003000500002
PURPOSE: to determine the prevalence of domestic physical violence among women who delivered at a tertiary center in the Northeast of Brazil, to study the main risk factors associated with domestic violence, and to determine perinatal outcome. METHODS: a cross-sectional study was conducted, enrolling 420 women who delivered at a tertiary center in Recife (Brazil) with fetuses weighing more than 500 g. They were submitted to interviews with open and closed questions. The prevalence of domestic physical violence was determined. Statistical analysis was performed using c² and Fisher's exact tests at a 5% level of significance. The prevalence ratio was determined as measurement of relative risk of violence. Multiple logistic regression analysis was performed and the adjusted risk was calculated. RESULTS: the prevalence of domestic physical violence was 13.1% (95% CI = 10.1-16.6) and 7.4% (95% CI = 5.2-10.2) before and during pregnancy, respectively. The pattern of violence has changed during pregnancy: stopped in 43.6%, was reduced in 27.3% and increased in 11% of the victims. After multivariate analysis the variables that persisted strongly associated with violence were low female educational level, history of violence in the women´s family, partner's use of alcohol and unemployment. Perinatal outcome was studied and a significantly higher frequency of neonatal death was observed among victims of domestic violence. CONCLUSIONS: a high prevalence of domestic physical violence was observed (about 13%) in women who delivered at a tertiary center in Northeast of Brazil. The main risk factors were low educational level and previous familiar history of violence in the women's family, alcohol use by and unemployment of their partners. Neonatal mortality was increased in victims of violence.
Summary
Rev Bras Ginecol Obstet. 1998;20(7):389-394
DOI 10.1590/S0100-72031998000700004
Most authors agree on the negative impact of pregnancy in women with advanced maternal age on maternal and perinatal outcome. However, it is not usual to evaluate if some considered risk factors are only confounders because they are present in women over forty years. In order to identify the isolated effect of age on maternal and perinatal outcome of pregnancies in women over forty, 494 pregnancies from this age group were compared to 988 pregnancies among women aged 20 to 29 years, matched by parity. After controlling possible confounding variables through multivariate analysis, advanced maternal age maintained its association with a higher prevalence of hypertension, malpresentation, cesarean section, postpartum hemorrhage, low Apgar score, perinatal death, late fetal death and intrapartum fetal distress. These findings show the need for adequate obstetrical care with special attention to those factors in order to improve maternal and perinatal outcome of pregnancies in women with advanced age.
Summary
Rev Bras Ginecol Obstet. 1998;20(7):389-394
DOI 10.1590/S0100-72031998000700004
Most authors agree on the negative impact of pregnancy in women with advanced maternal age on maternal and perinatal outcome. However, it is not usual to evaluate if some considered risk factors are only confounders because they are present in women over forty years. In order to identify the isolated effect of age on maternal and perinatal outcome of pregnancies in women over forty, 494 pregnancies from this age group were compared to 988 pregnancies among women aged 20 to 29 years, matched by parity. After controlling possible confounding variables through multivariate analysis, advanced maternal age maintained its association with a higher prevalence of hypertension, malpresentation, cesarean section, postpartum hemorrhage, low Apgar score, perinatal death, late fetal death and intrapartum fetal distress. These findings show the need for adequate obstetrical care with special attention to those factors in order to improve maternal and perinatal outcome of pregnancies in women with advanced age.
Summary
Rev Bras Ginecol Obstet. 1998;20(8):437-441
DOI 10.1590/S0100-72031998000800002
Purpose:to compare the incidence of preterm labor and birth, premature rupture of membranes (PROM) and low birth-weight newborns (< 2,500 g) between two groups of pregnant women (with or without BV). To verify the adequacy of including a regular prenatal BV investigation. Methods:a total of 217 women between 28 and 32 weeks of pregnancy (35 with BV and 182 without BV) were studied. The diagnosis of BV was established according to Amsel's criteria. The data were analyzed by the chi² test, Fisher's test, Mann-Whitney test and the relative risk. Results:the incidence of preterm labor, preterm birth, PROM and low birth-weight was statistically higher in the group of women with BV than in the control group (29.4% vs. 3.8%; 28.6% vs. 3.3%; 22.9% vs. 10.4%; 20.0% vs. 3.3%; respectively). The means of gestational age and birth-weight were significantly lower in the newborns from mothers with BV (265.8 days vs. 279.9 days; 2,958 g vs. 3,294 g, respectively). Conclusion:all perinatal complications studied were significantly associated with the presence of untreated BV during pregnancy. Therefore, the diagnosis and adequate treatment should be included in the routine prenatal assistance at Brazilian Obstetrics Services. Such measure may be effective in the reduction of these perinatal complications.
Summary
Rev Bras Ginecol Obstet. 1998;20(8):437-441
DOI 10.1590/S0100-72031998000800002
Purpose:to compare the incidence of preterm labor and birth, premature rupture of membranes (PROM) and low birth-weight newborns (< 2,500 g) between two groups of pregnant women (with or without BV). To verify the adequacy of including a regular prenatal BV investigation. Methods:a total of 217 women between 28 and 32 weeks of pregnancy (35 with BV and 182 without BV) were studied. The diagnosis of BV was established according to Amsel's criteria. The data were analyzed by the chi² test, Fisher's test, Mann-Whitney test and the relative risk. Results:the incidence of preterm labor, preterm birth, PROM and low birth-weight was statistically higher in the group of women with BV than in the control group (29.4% vs. 3.8%; 28.6% vs. 3.3%; 22.9% vs. 10.4%; 20.0% vs. 3.3%; respectively). The means of gestational age and birth-weight were significantly lower in the newborns from mothers with BV (265.8 days vs. 279.9 days; 2,958 g vs. 3,294 g, respectively). Conclusion:all perinatal complications studied were significantly associated with the presence of untreated BV during pregnancy. Therefore, the diagnosis and adequate treatment should be included in the routine prenatal assistance at Brazilian Obstetrics Services. Such measure may be effective in the reduction of these perinatal complications.
Summary
Rev Bras Ginecol Obstet. 2001;23(7):439-443
DOI 10.1590/S0100-72032001000700005
Purpose: to evaluate the percentage of 45- to 60-year-old women complaining of urinary incontinence, who look for medical treatment, and the factors possibly associated with the decision of visiting the doctor and the reasons for not doing so. Methods: a secondary analysis of a population-based survey on climacterium and menopause in women living in the city of Campinas, São Paulo state, was carried out through a descriptive, exploratory and cross-sectional population study. A total of 456 women between 45 and 60 years of age were selected through a sampling process. The age at menopause and its associated factors were evaluated, as well as the prevalence of climacteric symptoms, the use of medical care, self-perception of the health status, and the sociocultural, sociodemographic and socioeconomic characteristics. Urinary incontinence complaint and the search for medical help due to the presence of symptoms were explored. The data were collected through home interviews, using a structured and pretested questionnaire provided by the International Health Foundation/International Menopause Society and by the North American Menopause Society, and adapted by the authors. The statistical analysis was performed using Fisher's exact test. Results: thirty-five percent of the interviewees reported constant or intermittent stress incontinence, although only 59% of the patients with the complaint sought medical help. Conclusion: the majority of the women presenting urinary incontinence do not complain to the doctor if they are not questioned objectively.
Summary
Rev Bras Ginecol Obstet. 2001;23(7):439-443
DOI 10.1590/S0100-72032001000700005
Purpose: to evaluate the percentage of 45- to 60-year-old women complaining of urinary incontinence, who look for medical treatment, and the factors possibly associated with the decision of visiting the doctor and the reasons for not doing so. Methods: a secondary analysis of a population-based survey on climacterium and menopause in women living in the city of Campinas, São Paulo state, was carried out through a descriptive, exploratory and cross-sectional population study. A total of 456 women between 45 and 60 years of age were selected through a sampling process. The age at menopause and its associated factors were evaluated, as well as the prevalence of climacteric symptoms, the use of medical care, self-perception of the health status, and the sociocultural, sociodemographic and socioeconomic characteristics. Urinary incontinence complaint and the search for medical help due to the presence of symptoms were explored. The data were collected through home interviews, using a structured and pretested questionnaire provided by the International Health Foundation/International Menopause Society and by the North American Menopause Society, and adapted by the authors. The statistical analysis was performed using Fisher's exact test. Results: thirty-five percent of the interviewees reported constant or intermittent stress incontinence, although only 59% of the patients with the complaint sought medical help. Conclusion: the majority of the women presenting urinary incontinence do not complain to the doctor if they are not questioned objectively.
Summary
Rev Bras Ginecol Obstet. 2021;43(6):487-489
Summary
Rev Bras Ginecol Obstet. 2021;43(6):487-489
Summary
Rev Bras Ginecol Obstet. 1999;21(9):519-525
DOI 10.1590/S0100-72031999000900004
Purpose: to present the perinatal outcomes resulting from the use of a protocol for assistance to diabetic pregnant women used at the Center for Integral Assistance to Women's Health (CAISM), of the University of Campinas. Methods: ninety diabetic pregnant women, who were assisted at the institution with this protocol, were compared with two control grups: the first consisted of 180 pregnant women with equal number of gestations and same age (control A) and the second consisted of 180 randomly selected pregnant women (control B). The study variables were route of delivery, indication for cesarean section, gestational age, Apgar score at first and fifth minute, weight, adequacy of weight for gestational age and perinatal morbidity and mortality. For the statistical analysis Student's t-test and the chi2 test were used. Results: there was a higher incidence of cesarean sections, prematures and large to gestational age (LGA) babies among diabetic women, as well as higher occurrence of neonatal morbidity such as hypoglycemia, hypocalcemia, hyperbilirubinemia, respiratory distress and neonatal depression. The incidence of low Apgar score and perinatal mortality was significantly higher than in the randomly selected group, but the same as in the group matched regarding age and number of pregnancies. Conclusions: although this protocol intends to obtain a perfect metabolic control among diabetic pregnant women, the perinatal outcomes are still unfavorable in comparison to nondiabetic pregnant women.
Summary
Rev Bras Ginecol Obstet. 1999;21(9):519-525
DOI 10.1590/S0100-72031999000900004
Purpose: to present the perinatal outcomes resulting from the use of a protocol for assistance to diabetic pregnant women used at the Center for Integral Assistance to Women's Health (CAISM), of the University of Campinas. Methods: ninety diabetic pregnant women, who were assisted at the institution with this protocol, were compared with two control grups: the first consisted of 180 pregnant women with equal number of gestations and same age (control A) and the second consisted of 180 randomly selected pregnant women (control B). The study variables were route of delivery, indication for cesarean section, gestational age, Apgar score at first and fifth minute, weight, adequacy of weight for gestational age and perinatal morbidity and mortality. For the statistical analysis Student's t-test and the chi2 test were used. Results: there was a higher incidence of cesarean sections, prematures and large to gestational age (LGA) babies among diabetic women, as well as higher occurrence of neonatal morbidity such as hypoglycemia, hypocalcemia, hyperbilirubinemia, respiratory distress and neonatal depression. The incidence of low Apgar score and perinatal mortality was significantly higher than in the randomly selected group, but the same as in the group matched regarding age and number of pregnancies. Conclusions: although this protocol intends to obtain a perfect metabolic control among diabetic pregnant women, the perinatal outcomes are still unfavorable in comparison to nondiabetic pregnant women.
