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Original Article08-29-2005
Hyperthyroidism due to Graves’ disease during pregnancy
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(5):263-267
Abstract
Original ArticleHyperthyroidism due to Graves’ disease during pregnancy
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(5):263-267
DOI 10.1590/S0100-72032005000500006
Views72See morePURPOSE: to evaluate the influence of hyperthyroidism during pregnancy and the necessity of changing antithyroid drug dose in this period and after delivery. METHODS: prospective evaluation of clinical and laboratorial findings of thirteen pregnancies in eleven pregnant women with hyperthyroidism due to Graves' disease. These women were evaluated through TSH and serum free T4 at each trimester or four weeks after setting thionamide dosage. The goal was to maintain free T4 in the superior third of the normal range using the lowest possible thionamide dose. RESULTS: the mean age at the beginning of the pregnancy was 31.1 years (23 to 41). The mean dosage of thionamide was reduced in eight pregnancies (69.5%) and, in two, the drug was discontinued. Before pregnancy, mean propylthiouracil dose was 400 mg/day (200-900) and mean methimazole dose was 45 mg/day (20-60). After delivery, antithyroid drug dose was 200 and 30 mg/day, respectively. One patient presented premature labor (at 36 weeks) and another, a newborn small for gestational age (2.000 g at 38 weeks). There was one stillborn. There were no miscarriages or congenital anomalies. After labor, antithyroid drug dose was increased in seven patients and in the others the dose was maintained. CONCLUSIONS: we suggest close follow-up of pregnant women with hyperthyroidism and progressive reduction of thionamide dose during pregnancy to avoid maternal hypothyroidism and its consequences to fetal development. After labor, these women must be evaluated regarding their thyroid function because hyperthyroidism can worsen. Thionamide use is safe for the patients and their offspring.
Views72
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleHyperthyroidism due to Graves’ disease during pregnancy
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(5):263-267
DOI 10.1590/S0100-72032005000500006
Views72See morePURPOSE: to evaluate the influence of hyperthyroidism during pregnancy and the necessity of changing antithyroid drug dose in this period and after delivery. METHODS: prospective evaluation of clinical and laboratorial findings of thirteen pregnancies in eleven pregnant women with hyperthyroidism due to Graves' disease. These women were evaluated through TSH and serum free T4 at each trimester or four weeks after setting thionamide dosage. The goal was to maintain free T4 in the superior third of the normal range using the lowest possible thionamide dose. RESULTS: the mean age at the beginning of the pregnancy was 31.1 years (23 to 41). The mean dosage of thionamide was reduced in eight pregnancies (69.5%) and, in two, the drug was discontinued. Before pregnancy, mean propylthiouracil dose was 400 mg/day (200-900) and mean methimazole dose was 45 mg/day (20-60). After delivery, antithyroid drug dose was 200 and 30 mg/day, respectively. One patient presented premature labor (at 36 weeks) and another, a newborn small for gestational age (2.000 g at 38 weeks). There was one stillborn. There were no miscarriages or congenital anomalies. After labor, antithyroid drug dose was increased in seven patients and in the others the dose was maintained. CONCLUSIONS: we suggest close follow-up of pregnant women with hyperthyroidism and progressive reduction of thionamide dose during pregnancy to avoid maternal hypothyroidism and its consequences to fetal development. After labor, these women must be evaluated regarding their thyroid function because hyperthyroidism can worsen. Thionamide use is safe for the patients and their offspring.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article07-30-2005
Factors associated with the severity of maternal morbidity for the characterization of near miss
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(4):197-203
Abstract
Original ArticleFactors associated with the severity of maternal morbidity for the characterization of near miss
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(4):197-203
DOI 10.1590/S0100-72032005000400006
Views113See morePURPOSE: to apply a severity score to cases of severe maternal morbidity (SMM) and to compare the classification criteria. METHODS: a control-case study was performed as a secondary analysis of cases of SMM in a tertiary level maternity unit for a period of 12-month. A specific score for assessing the degree of severity was applied to cases identified as SMM. Twenty cases of near miss maternal morbidity (higher severity) were compared to 104 control cases (lower severity) of other severe morbidities, regarding risk factors, primary determinants and assistance requirements. Analyses were performed with means and proportions, using Student's t, Wilcoxon and chi2 statistical tests, and estimations of OR and 95% CI. RESULTS: the higher severity (near miss) was identified in 16.1% of cases and the history of abortion was the only factor statistically associated with it (OR=3.41, 95% CI 1.08-10.79). In fact, the indices of assistance complexity were more frequent in the near-miss morbidity group, which also presented less hypertension (30% against 62.5%) and more hemorrhage (35.5% against 10.6%) as primary determinant factors of severe morbidity. CONCLUSIONS: the higher severity of maternal morbidity was associated with a history of abortion and with hemorrhage as a cause. The applied score was able to identify a higher severity subgroup (near miss), which needs more complex professional and institutional care in order to avoid the occurrence of death.
Views113This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleFactors associated with the severity of maternal morbidity for the characterization of near miss
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(4):197-203
DOI 10.1590/S0100-72032005000400006
Views113See morePURPOSE: to apply a severity score to cases of severe maternal morbidity (SMM) and to compare the classification criteria. METHODS: a control-case study was performed as a secondary analysis of cases of SMM in a tertiary level maternity unit for a period of 12-month. A specific score for assessing the degree of severity was applied to cases identified as SMM. Twenty cases of near miss maternal morbidity (higher severity) were compared to 104 control cases (lower severity) of other severe morbidities, regarding risk factors, primary determinants and assistance requirements. Analyses were performed with means and proportions, using Student's t, Wilcoxon and chi2 statistical tests, and estimations of OR and 95% CI. RESULTS: the higher severity (near miss) was identified in 16.1% of cases and the history of abortion was the only factor statistically associated with it (OR=3.41, 95% CI 1.08-10.79). In fact, the indices of assistance complexity were more frequent in the near-miss morbidity group, which also presented less hypertension (30% against 62.5%) and more hemorrhage (35.5% against 10.6%) as primary determinant factors of severe morbidity. CONCLUSIONS: the higher severity of maternal morbidity was associated with a history of abortion and with hemorrhage as a cause. The applied score was able to identify a higher severity subgroup (near miss), which needs more complex professional and institutional care in order to avoid the occurrence of death.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article01-04-2000
Comparative Study of Maternal and Perinatal Outcomes among Patients with Pregestational Type I and Type II Diabetes
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(5):257-263
Abstract
Original ArticleComparative Study of Maternal and Perinatal Outcomes among Patients with Pregestational Type I and Type II Diabetes
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(5):257-263
DOI 10.1590/S0100-72032000000500002
Views122See morePurpose: to evaluate the evolution of gestation, metabolic control and perinatal outcome of pregestational diabetic patients and to perform a comparative study of the results of patients with insulin-dependent diabetes (type I) and non-insulin-dependent diabetes (type II). Methods: retrospective analysis of 57 pregestational diabetic woman charts who began a prenatal follow-up in the Service of Maternofetal Medicine of the Maternidade-Escola Assis Chateaubriand of the Universidade Federal do Ceará, in the period from January 1995 to December 1998. The 57 pregnant women included in the study were divided into groups: the first, composed of 28 patients with insulin-dependent diabetes (type I), and the second with 29 pregnant women with non-insulin-dependent diabetes (type II), controlled with diet or with oral hypoglycemics before pregnancy. Results: there was no statistically significant difference between the two groups in relation to the need of hospitalization for glycemia control (39.2% x 27.5%) and maternal complications, such as: chronic arterial hypertension (14.2% x 27.5%), pregnancy-induced hypertension (14.2% x 17.2%), premature rupture of membranes (3.5% x 10.3%), urinary tract infection (10.7% x 6.8%), and preterm labor (3.5% x 6.8%). However, episodes of maternal hypoglycemia were more frequent among insulin-dependent patients (35.7% x 3.4%). The perinatal results were similar. We observed a great number of congenital anomalies and increased perinatal morbidity and mortality. Conclusion: there was no difference in the incidence of obstetric and clinical complications between insulin-dependent and non-insulin-dependent patients, except for maternal hypoglycemia.
Views122This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleComparative Study of Maternal and Perinatal Outcomes among Patients with Pregestational Type I and Type II Diabetes
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(5):257-263
DOI 10.1590/S0100-72032000000500002
Views122See morePurpose: to evaluate the evolution of gestation, metabolic control and perinatal outcome of pregestational diabetic patients and to perform a comparative study of the results of patients with insulin-dependent diabetes (type I) and non-insulin-dependent diabetes (type II). Methods: retrospective analysis of 57 pregestational diabetic woman charts who began a prenatal follow-up in the Service of Maternofetal Medicine of the Maternidade-Escola Assis Chateaubriand of the Universidade Federal do Ceará, in the period from January 1995 to December 1998. The 57 pregnant women included in the study were divided into groups: the first, composed of 28 patients with insulin-dependent diabetes (type I), and the second with 29 pregnant women with non-insulin-dependent diabetes (type II), controlled with diet or with oral hypoglycemics before pregnancy. Results: there was no statistically significant difference between the two groups in relation to the need of hospitalization for glycemia control (39.2% x 27.5%) and maternal complications, such as: chronic arterial hypertension (14.2% x 27.5%), pregnancy-induced hypertension (14.2% x 17.2%), premature rupture of membranes (3.5% x 10.3%), urinary tract infection (10.7% x 6.8%), and preterm labor (3.5% x 6.8%). However, episodes of maternal hypoglycemia were more frequent among insulin-dependent patients (35.7% x 3.4%). The perinatal results were similar. We observed a great number of congenital anomalies and increased perinatal morbidity and mortality. Conclusion: there was no difference in the incidence of obstetric and clinical complications between insulin-dependent and non-insulin-dependent patients, except for maternal hypoglycemia.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article11-23-2004
Social indicators of pregnant adolescents: a case control study
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(8):633-639
Abstract
Original ArticleSocial indicators of pregnant adolescents: a case control study
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(8):633-639
DOI 10.1590/S0100-72032004000800007
Views144See morePURPOSE: to check whether there were differences in some social indicators between adolescent and adult pregnant women in the city of Ribeirão Preto, from January 1992 to December 1996. METHODS: the information was obtained from hospital discharge forms and was analyzed at the Hospital Data Processing Center of the FMRP-USP. The analyzed parameters were: number and types of deliveries, category of hospital admission, occupation, and obstetric diagnosis. The 6.04a text processor Epi-Info System, a data bank and statistics of epidemiology produced by the Centers of Disease Control and Prevention (Atlanta, GA, USA), and Dbase IV were used to process the information. The association between variables was tested by the chi² test, with level of significance set at 5%, using the GraphPad Prism version 2.0, 1995 software. RESULTS: a total of 43,253 deliveries occurred during this period, among which 7,134 (16.5%) corresponded to adolescent deliveries, while 36,119 (83.5%) to adult deliveries. The number of deliveries by adolescent girls increased 25.5% along this period. The proportion of adolescent deliveries in the unified health system category of admission increased, and it was higher than that of the adults'. Only 14.1% of the adolescents belonged to the economically active population, comparing with 34.8% of the adults. Only 6.8% of the adolescents were students, while 79.0% were house-workers or had a nonpaid occupation. In the analyzed period, the ratio of vaginal delivery increased among the adolescents, as compared to that of the adults. The ratio of cesarean delivery persisted stable and higher among the adults. Premature delivery and false labor were significantly more frequent among the adolescents. CONCLUSION: the number of deliveries increased among the adolescents, and most of them were normal. The ratio of admission by the unified health system category and that of vaginal delivery were higher among the adolescents. There were more adolescents without an economically active work. Thus, we recommend strategies to prevent adolescent pregnancy, mainly among the poor population.
Views144This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleSocial indicators of pregnant adolescents: a case control study
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(8):633-639
DOI 10.1590/S0100-72032004000800007
Views144See morePURPOSE: to check whether there were differences in some social indicators between adolescent and adult pregnant women in the city of Ribeirão Preto, from January 1992 to December 1996. METHODS: the information was obtained from hospital discharge forms and was analyzed at the Hospital Data Processing Center of the FMRP-USP. The analyzed parameters were: number and types of deliveries, category of hospital admission, occupation, and obstetric diagnosis. The 6.04a text processor Epi-Info System, a data bank and statistics of epidemiology produced by the Centers of Disease Control and Prevention (Atlanta, GA, USA), and Dbase IV were used to process the information. The association between variables was tested by the chi² test, with level of significance set at 5%, using the GraphPad Prism version 2.0, 1995 software. RESULTS: a total of 43,253 deliveries occurred during this period, among which 7,134 (16.5%) corresponded to adolescent deliveries, while 36,119 (83.5%) to adult deliveries. The number of deliveries by adolescent girls increased 25.5% along this period. The proportion of adolescent deliveries in the unified health system category of admission increased, and it was higher than that of the adults'. Only 14.1% of the adolescents belonged to the economically active population, comparing with 34.8% of the adults. Only 6.8% of the adolescents were students, while 79.0% were house-workers or had a nonpaid occupation. In the analyzed period, the ratio of vaginal delivery increased among the adolescents, as compared to that of the adults. The ratio of cesarean delivery persisted stable and higher among the adults. Premature delivery and false labor were significantly more frequent among the adolescents. CONCLUSION: the number of deliveries increased among the adolescents, and most of them were normal. The ratio of admission by the unified health system category and that of vaginal delivery were higher among the adolescents. There were more adolescents without an economically active work. Thus, we recommend strategies to prevent adolescent pregnancy, mainly among the poor population.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Case Report10-15-2004
Paroxysmal nocturnal hemoglobinuria in pregnancy
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):579-582
Abstract
Case ReportParoxysmal nocturnal hemoglobinuria in pregnancy
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):579-582
DOI 10.1590/S0100-72032004000700011
Views90See moreParoxysmal nocturnal hemoglobinuria is a rare disease caused by an acquired gene mutation of the hematopoietic system, with 16-18% of the cases diagnosed during pregnancy. We describe two cases of pregnancy in women with paroxysmal nocturnal hemoglobinuria. Maternal mortality reaches 8-10%, mainly due to thromboembolism and, less frequently, to leukemic transformation. Fetal losses may reach 30%. These two cases illustrate a serious and extremely complex situation, which is the obstetrical management of a patient with a very rare, serious and potentially fatal hematological condition. Using a multidisciplinary approach in tertiary care centers, it is possible to attain good maternal and perinatal outcomes.
Views90This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Case ReportParoxysmal nocturnal hemoglobinuria in pregnancy
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):579-582
DOI 10.1590/S0100-72032004000700011
Views90See moreParoxysmal nocturnal hemoglobinuria is a rare disease caused by an acquired gene mutation of the hematopoietic system, with 16-18% of the cases diagnosed during pregnancy. We describe two cases of pregnancy in women with paroxysmal nocturnal hemoglobinuria. Maternal mortality reaches 8-10%, mainly due to thromboembolism and, less frequently, to leukemic transformation. Fetal losses may reach 30%. These two cases illustrate a serious and extremely complex situation, which is the obstetrical management of a patient with a very rare, serious and potentially fatal hematological condition. Using a multidisciplinary approach in tertiary care centers, it is possible to attain good maternal and perinatal outcomes.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Case Report05-07-2004
Pustular psoriasis of pregnancy (impetigo herpetiformis): a report of two cases and review of the literature
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):153-159
Abstract
Case ReportPustular psoriasis of pregnancy (impetigo herpetiformis): a report of two cases and review of the literature
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):153-159
DOI 10.1590/S0100-72032004000200011
Views124See morePustular psoriasis of pregnancy is a rare pustular dermatosis with eruptions that develop in groups of sterile pustules at the periphery of erythematous patches of the skin. Systemic symptoms include high fever, malaise, diarrhea, delirium, dehydration, tetany, and convulsions. Therapy with systemic corticosteroids, antibiotics, replacement of fluid and electrolytes is mandatory. In this report, we present the cases of two primigravidas, 23 and 28 years old, who presented pustular psoriasis of pregnancy at the 24th and 28th week of gestation. They were treated and, in the first case, a healthy 2,500-g female fetus was born vaginally, after labor induction with oxytocin at the 35th week of gestation; in the second patient, at the 37th week of gestation, after a moderate vaginal bleeding and no perception of fetal movements for 12 hours, a stillborn 2,700-g female was born after labor induction with prostaglandin.
Views124This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Case ReportPustular psoriasis of pregnancy (impetigo herpetiformis): a report of two cases and review of the literature
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(2):153-159
DOI 10.1590/S0100-72032004000200011
Views124See morePustular psoriasis of pregnancy is a rare pustular dermatosis with eruptions that develop in groups of sterile pustules at the periphery of erythematous patches of the skin. Systemic symptoms include high fever, malaise, diarrhea, delirium, dehydration, tetany, and convulsions. Therapy with systemic corticosteroids, antibiotics, replacement of fluid and electrolytes is mandatory. In this report, we present the cases of two primigravidas, 23 and 28 years old, who presented pustular psoriasis of pregnancy at the 24th and 28th week of gestation. They were treated and, in the first case, a healthy 2,500-g female fetus was born vaginally, after labor induction with oxytocin at the 35th week of gestation; in the second patient, at the 37th week of gestation, after a moderate vaginal bleeding and no perception of fetal movements for 12 hours, a stillborn 2,700-g female was born after labor induction with prostaglandin.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Case Report04-13-2003
Ehlers-Danlos syndrome and pregnancy: a case report
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):745-748
Abstract
Case ReportEhlers-Danlos syndrome and pregnancy: a case report
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):745-748
DOI 10.1590/S0100-72032003001000008
Views100See moreEhlers-Danlos syndrome is a connective tissue disease that is rarely associated with pregnancy, but with potentially fatal complications during pregnancy and puerperium, such as vascular and intestinal ruptures. It can also be associated with joint laxity and pain in women; during pregnancy there is a greater risk of prematurity, because of premature rupture of membranes and/or cervical insufficiency. Uterine rupture and inversion can also be associated with this syndrome. In the present study, we describe the case of a pregnant woman with Ehlers-Danlos syndrome, with a favorable evolution, without fetal complications and a good perinatal outcome.
Views100This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Case ReportEhlers-Danlos syndrome and pregnancy: a case report
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):745-748
DOI 10.1590/S0100-72032003001000008
Views100See moreEhlers-Danlos syndrome is a connective tissue disease that is rarely associated with pregnancy, but with potentially fatal complications during pregnancy and puerperium, such as vascular and intestinal ruptures. It can also be associated with joint laxity and pain in women; during pregnancy there is a greater risk of prematurity, because of premature rupture of membranes and/or cervical insufficiency. Uterine rupture and inversion can also be associated with this syndrome. In the present study, we describe the case of a pregnant woman with Ehlers-Danlos syndrome, with a favorable evolution, without fetal complications and a good perinatal outcome.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Case Report10-24-2000
Parkinson’s Disease and Pregnancy: Case Report
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):381-384
Abstract
Case ReportParkinson’s Disease and Pregnancy: Case Report
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):381-384
DOI 10.1590/S0100-72032000000600009
Views75See moreParkinson's disease is characterized by tremor, stiffness of the musculature, bradykinesia, and postural and march abnormalities. It attacks all ethnic groups, with no sex preference, frequently in the 45-50-year range. The diagnosis is essentially clinical. The association with pregnancy is rare. The experience with that association is scarse, some questions remaining without answer. The authors describe a case of Parkinson's disease and gestation with satisfactory evolution, in spite of the clinical worsening during pregnancy. The mother presented elevation of blood pressure levels, alterations of the hepatic enzymes, and oligohydramnios. She used, independently, selegiline until the third month, and, later on, amantadine. The newborn presented low weight, respiratory distress and jaundice, being discharged from the hospital, with no other complications, on the fourth day of life.
Views75This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Case ReportParkinson’s Disease and Pregnancy: Case Report
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):381-384
DOI 10.1590/S0100-72032000000600009
Views75See moreParkinson's disease is characterized by tremor, stiffness of the musculature, bradykinesia, and postural and march abnormalities. It attacks all ethnic groups, with no sex preference, frequently in the 45-50-year range. The diagnosis is essentially clinical. The association with pregnancy is rare. The experience with that association is scarse, some questions remaining without answer. The authors describe a case of Parkinson's disease and gestation with satisfactory evolution, in spite of the clinical worsening during pregnancy. The mother presented elevation of blood pressure levels, alterations of the hepatic enzymes, and oligohydramnios. She used, independently, selegiline until the third month, and, later on, amantadine. The newborn presented low weight, respiratory distress and jaundice, being discharged from the hospital, with no other complications, on the fourth day of life.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Pregnancy complications Archives - Page 11 of 11 - Revista Brasileira de Ginecologia e Obstetrícia
