Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(1):4-8
This study aims to give information about the relationship between different types of factor deficiencies and maternal/obstetric outcomes.
We retrospectively reviewed the medical records of eight women with factor deficiency disorders. The demographic and clinical features of the patients after their last pregnancies were registered retrospectively.
There were 29 pregnancies among the 8 patients. The spontaneous abortion rate was relatively high in two patients with factor XIII deficiency (80% and 57.1%) compared with the other factor deficiency groups. There were 16 births, which included 1 set of twins, and 2 deaths (1 stillbirth and 1 postpartum exitus occurred in the same patient). Intrauterine growth restriction was noted in five cases; four of these occurred in factor X deficiency cases. The mean decrease in hemoglobin level of all patients after birth was 1.7 g/dL (range, 0.2-3.6 g/dL). Red blood cell transfusion was required only in one case of factor XIII deficiency.
There is currently no consensus on the pregnancy management of women with factor deficiencies because of the limited knowledge due to the rarity of such disorders. Labor should be managed in a dedicated unit with a team consisting of an obstetrician, a hematologist, an anesthesiologist, a midwife, and a pediatrician to minimalize the complications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(1):40-45
DOI 10.1590/S0100-72032014000100009
To analyze the cytological findings of women with cervical adenocarcinoma, taking
into account the patient's history in the year prior to diagnosis and the
histopathological aspects of the lesions.
A retrospective comparative study was conducted using data from women with
cervical adenocarcinoma or squamous carcinoma detected between 2002 and 2008. The
cytological reports were synthesized according to the Bethesda System revised in
2001 and were compared to the histopathological findings of cervical
adenocarcinoma and squamous carcinoma. The distributions of cytological findings
were calculated, as well as the global agreement and chance-corrected agreement
using the Cohen's Kappa Coefficient. For this purpose, the cytological findings
were grouped according to the epithelial origin, forming the glandular cell and
squamous cell groups, with the histopathologically confirmed tumor types
(adenocarcinoma versus squamous carcinoma) being used as the gold
standard.
A total of 284 cases of cervical cancer were diagnosed during the study period.
The effectively studied cases were 27 and 54 patients with adenocarcinoma and
squamous carcinoma, respectively. The adenocarcinoma group represented 9.5% of the
total cases diagnosed, and 56.0% of the women in this group were younger than 50
years. Cervical cytology was collected on average 92 days before the cancer
diagnosis (range: 19 days to 310 days). In 41.6% of cases the cytological results
were consistent with glandular alterations such as adenocarcinoma cells or
atypical glandular cells. The global agreement and Cohen's Kappa Coefficient were
73.7 and 48.7%, suggesting substantial and moderate agreement, respectively.
In this population, the cytological smears had an important role in screening
women with adenocarcinoma, although some of them were referred to clarify the
clinical symptoms. The agreement between cytological and histopathological
findings was moderate.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(1):40-46
To analyze the quantity of cervical smears, also designated Papanicolaou tests, between 2006 and 2015 in all the Federal units of Brazil, as well as to verify the quantity of exams collected outside the recommended age range and the economic impact of such excess.
The data was collected from the Ministry of Health’s database called Sistema de Informação do Câncer do Colo de Útero (SISCOLO), which contains all the test results collected nationwide by the Unified Health System (SUS, in the Portuguese acronym). From that, the number of exams and the age range of thewomen who underwent them were analyzed; besides, these numbers were stratified according to the state of where the exam was performed. The quantity of exams collected outside the recommended age range was verified, and, so, the economic impact generated was noted.
Between 2006and2015, 87,425,549Papanicolaoutestswere collected in Brazil. Of these, 20,215,052 testswere collected outside the age range recommended by the Brazilian Ministry of Health; this number corresponded to 23.12% of all exams. From such data, considering that each Pap smear collected by SUS generates a cost of BRL 7.30 to the government, according to the information in the Tabela SUS dated September 2018, there was a total charge of BRL 147,569,880 for tests collected outside the protocol.
In Brazil, according to the Ministry of Health’s protocol about the recommended practices on collecting Pap smears, whose newest edition dates of 2016, it is recommended that Pap smears are collected inwomen from a specific age range, inwhom the potential diagnosing advantages overcome the onus of overdiagnosis or of a lesion with great regression potential. However, such protocols have not been correctly followed, promoting more than 20 million tests in excess, and an exorbitant cost for the Brazilian public health system. It is relevant to take measures to correctly use the official protocol, reducing the patients risks, as well as the economic impact for SUS.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(1):40-46
DOI 10.1590/S0100-72032012000100008
PURPOSE: To determine the frequency and the association of serum markers for inherited and acquired thrombophilias in pregnant women with a history of severe pre-eclampsia in previous pregnancies. METHODS: Case-control study consisting of 81 pregnant women with a history of severe pre-eclampsia in previous pregnancies (study group) and 32 women with no history of severe pre-eclampsia in previous pregnancies (control group). The presence of inherited thrombophilia and antiphospholipid antibodies was screened in both groups. We used the chi-square test with Yates correction to assess associations and calculate the relative risks. RESULTS: The presence of thrombophilia was detected in 60.0% of patients with a previous history of pre-eclampsia and in 6.0% of the control patients. A significant association was found between pre-eclampsia in a previous pregnancy and the presence of markers for hereditary thrombophilia/antiphospholipid antibodies (p<0.05). The relative risk to develop pre-eclampsia was found to be 1.57 (1.34
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(12):401-407
DOI 10.1590/S0100-72032011001200005
PURPOSE: To evaluate the epidemiological and clinical aspects of gynecological patients seeking care in the private and public health networks. METHODS: In this cross-sectional study we analyzed the records of 243 patients (122 public service patients and 121 private service ones), from January 2007 to January 2008. We excluded records of pregnant patients with vaginal bleeding, history of using vaginal creams or gels at intervals of less than 15 days and patients who had sexual intercourse within less than five days before their visit and with incomplete clinical data. Data were analyzed statistically using the Stata software, version 9.2, with a 5% level of significance. RESULTS: The mean age of the patients attending the public health service was 27±12 years-old and 25.9±10.4 years-old for patients attending the private health service, with no statistical difference between means (F=0.5 and p=0.4). Patients attending the public health service had lower education (p<0.001), they were preferentially housewives (p<0.001), began sexual life early, had a greater number of partners (p<0.001), of pregnancies (p<0.001) and of deliveries (p=0.004), and mainly used the condom as a contraceptive method (p=0.013). There was no statistical difference between groups regarding the history of sexual transmitted diseases, diagnosis of candidiasis, bacterial vaginosis, trichomoniasis, or neoplasia. CONCLUSIONS: Patients attending the public health service have a higher number of pregnancies and births. They are usually housewives with low educational level, their sex life begins early, and they have more partners. However, there was no difference between groups when evaluating breast diseases, gynecological infections, or cancer of the cervix, which suggests that socioeconomic status is not the only element in the determination of the disease and, therefore, other variables should be evaluated.