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Revista Brasileira de Ginecologia e Obstetrícia. 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
Revista Brasileira de Ginecologia e Obstetrícia. 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
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):89-96
DOI 10.1590/S0100-72032004000200002
PURPOSE: to evaluate knowledge, opinion and practice of gynecologists/obstetricians regarding induction of abortion. Method: a pretested, structured questionnaire was sent to gynecologists/obstetricians affiliated to FEBRASGO. They were asked to answer and return the questionnaire in a self-addressed, prepaid envelope, without identification of the respondent so as to preserve anonymity. Knowledge about the legal situation of abortion in Brazil, opinion about it and practice if confronted with abortion requests were questioned. RESULTS: approximately 90% of the respondents believed that abortion is legal for pregnancy resulting from rape or in case of risk to a woman's life and for 31.8% in case of severe fetal malformation. In their opinion abortion should be permitted in the case that pregnancy is a risk for a woman's life (79.3%), fetal malformation (77.0%) and after rape (76.6%), added to 9.9% who expressed that abortion should be permitted in all circumstances. Two thirds wrongly thought that a judicial order is required to practice a legal abortion and only 27.4% knew that a written request by the woman is required. Confronted with unwanted pregnancy, 77.6% of female gynecologists/obstetricians and 79.9% of partners of male respondents had an abortion, 40% would help a client and 48.5% a relative in the same situation. CONCLUSION: gynecologists/obstetricians lack knowledge on the legal situation of abortion although their opinion and practice are favorable.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):89-96
DOI 10.1590/S0100-72032004000200002
PURPOSE: to evaluate knowledge, opinion and practice of gynecologists/obstetricians regarding induction of abortion. Method: a pretested, structured questionnaire was sent to gynecologists/obstetricians affiliated to FEBRASGO. They were asked to answer and return the questionnaire in a self-addressed, prepaid envelope, without identification of the respondent so as to preserve anonymity. Knowledge about the legal situation of abortion in Brazil, opinion about it and practice if confronted with abortion requests were questioned. RESULTS: approximately 90% of the respondents believed that abortion is legal for pregnancy resulting from rape or in case of risk to a woman's life and for 31.8% in case of severe fetal malformation. In their opinion abortion should be permitted in the case that pregnancy is a risk for a woman's life (79.3%), fetal malformation (77.0%) and after rape (76.6%), added to 9.9% who expressed that abortion should be permitted in all circumstances. Two thirds wrongly thought that a judicial order is required to practice a legal abortion and only 27.4% knew that a written request by the woman is required. Confronted with unwanted pregnancy, 77.6% of female gynecologists/obstetricians and 79.9% of partners of male respondents had an abortion, 40% would help a client and 48.5% a relative in the same situation. CONCLUSION: gynecologists/obstetricians lack knowledge on the legal situation of abortion although their opinion and practice are favorable.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 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
Revista Brasileira de Ginecologia e Obstetrícia. 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
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(9):579-584
DOI 10.1590/S0100-72032000000900007
Purpose: to evaluate the avoidable mortality among women in reproductive age, living in Campinas, SP, comparing two five-year periods: 1985-89 and 1990-94. Methods: death certificates of 3.086 women aged 10 to 49 years were studied, representing the total number of deaths during the period from January 1985 through December 1994. The criteria for avoidance were applied to these deaths using preventive, sanitary, early diagnosis and treatment, and mixed measures. The deaths were also classified as: with hardly avoidable causes, not well-defined causes and other causes. The specific mortality coefficient for each period of five years and the ratio between these coefficients were calculated. Results: there was a 20% increase in the avoidable mortality rate from the first to the second period. The main failure was observed among the group of avoidable causes by preventive and sanitary measures. The main increase in death causes by preventive measures resulted from AIDS. Among the causes of death avoidable by mixed measures, the increase of 50% in maternal mortality caused by abortion, as well as causes due to violence specially homicides, are emphasized. Conclusion: there was an increase in the proportion of avoidable death causes. Measures to prevent AIDS, abortion and to reduce violent deaths, specially homicides, should be political and social priorities in our Country.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(9):579-584
DOI 10.1590/S0100-72032000000900007
Purpose: to evaluate the avoidable mortality among women in reproductive age, living in Campinas, SP, comparing two five-year periods: 1985-89 and 1990-94. Methods: death certificates of 3.086 women aged 10 to 49 years were studied, representing the total number of deaths during the period from January 1985 through December 1994. The criteria for avoidance were applied to these deaths using preventive, sanitary, early diagnosis and treatment, and mixed measures. The deaths were also classified as: with hardly avoidable causes, not well-defined causes and other causes. The specific mortality coefficient for each period of five years and the ratio between these coefficients were calculated. Results: there was a 20% increase in the avoidable mortality rate from the first to the second period. The main failure was observed among the group of avoidable causes by preventive and sanitary measures. The main increase in death causes by preventive measures resulted from AIDS. Among the causes of death avoidable by mixed measures, the increase of 50% in maternal mortality caused by abortion, as well as causes due to violence specially homicides, are emphasized. Conclusion: there was an increase in the proportion of avoidable death causes. Measures to prevent AIDS, abortion and to reduce violent deaths, specially homicides, should be political and social priorities in our Country.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 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
Revista Brasileira de Ginecologia e Obstetrícia. 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
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(2):121-127
DOI 10.1590/S0100-72032002000200008
Purpose: to estimate the performance of ultrasound to detect gestations at risk for fetal chromosomal abnormalities. Methods: four hundred and thirty-six patients selected for the study had undergone ultrasound examination and fetal karyotyping, between March 1993 and March 1998. Two hundred and seventy-seven patients had fetal karyotype for fetal malformation detected on ultrasound and 158 for parental anxiety with normal ultrasound examination. Ultrasound sensitivity and specificity were calculated using fetal karyotype as gold standard. The relative risk for each chromosomal abnormality was calculated according to the altered system on ultrasound examination and the risks of the presence of one or more abnormalities on ultrasound, using the Epi-Info 6.0 software package for statistical analysis. Results: the relative risks for chromosomal abnormalities were 89 for face malformations, 53 for abdominal wall and cardiovascular, 49.6 for neck, 44.6 for extremities, 42.4 for lung, 32.7 for gastrointestinal tract, 27.4 for central nervous system and 23.0 for urinary tract malformations. The relative risk for fetal chromosomal anomalies for genital, thorax, spine and muscle and/or skeletal malformations was not appropriate for calculation because they occurred at very low frequencies. An isolated malformation detected by ultrasound is associated with a 7.8 times higher relative risk for chromosomal anomalies than none, and associated morphologic malformations have a 33.8 times higher relative risk for chromosomal abnormalities. Conclusion: ultrasound has good performance to detect gestations at risk for chromosomal abnormalities.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(2):121-127
DOI 10.1590/S0100-72032002000200008
Purpose: to estimate the performance of ultrasound to detect gestations at risk for fetal chromosomal abnormalities. Methods: four hundred and thirty-six patients selected for the study had undergone ultrasound examination and fetal karyotyping, between March 1993 and March 1998. Two hundred and seventy-seven patients had fetal karyotype for fetal malformation detected on ultrasound and 158 for parental anxiety with normal ultrasound examination. Ultrasound sensitivity and specificity were calculated using fetal karyotype as gold standard. The relative risk for each chromosomal abnormality was calculated according to the altered system on ultrasound examination and the risks of the presence of one or more abnormalities on ultrasound, using the Epi-Info 6.0 software package for statistical analysis. Results: the relative risks for chromosomal abnormalities were 89 for face malformations, 53 for abdominal wall and cardiovascular, 49.6 for neck, 44.6 for extremities, 42.4 for lung, 32.7 for gastrointestinal tract, 27.4 for central nervous system and 23.0 for urinary tract malformations. The relative risk for fetal chromosomal anomalies for genital, thorax, spine and muscle and/or skeletal malformations was not appropriate for calculation because they occurred at very low frequencies. An isolated malformation detected by ultrasound is associated with a 7.8 times higher relative risk for chromosomal anomalies than none, and associated morphologic malformations have a 33.8 times higher relative risk for chromosomal abnormalities. Conclusion: ultrasound has good performance to detect gestations at risk for chromosomal abnormalities.