Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(1):28-34
DOI 10.1590/S0100-72032009000100006
PURPOSE: to determine the prevalence of depression and anxiety in climacteric women and the probable factors responsible for its occurrence. METHODS: a transversal study that has selected 93 women attended at a climacteric outpatient clinic, from May 2006 to August 2007. Inclusion criteria were: women from 40 to 65 years old who agreed with participating in the project. Exclusion criteria: patients in hormonal therapy, hormone-therapy by implant, DIUs and depo injections in the preceding six months, endocrinopathies leading to menstrual irregularities, hepatopathies, thrombopathies, use of drugs which interfere in the menstrual cycle, anxiolytics and antidepressants (as their use indicates previous diagnosis of mood disorders), hysterectomy, oophorectomy, cancer or psychiatric disease, and patients who had been submitted to radio or chemotherapy. During the interview, four questionnaires were applied: Anamnesis, containing socio-demographic, clinical and living habits data; Blatt-Kupperman's Menopausal Index for climacteric syndrome diagnosis; Anxiety sub-scale of the Hospital Anxiety and Depression scale (HADS-A) for anxiety diagnosis; and Beck's Depression Inventory for the diagnosis of depression. Descriptive and correlation analysis among the variables, χ2 and Hosmer-Lemeshow tests were performed using the Statistica Software program, version 6. RESULTS: the average depression prevalence among the patients was 36.8%, while that of anxiety was 53.7%. There was no significant difference between the prevalence of depression and anxiety in the three phases of climacterium. There was a significant relationship between the presence of moderate climacteric symptoms and the presence of mood alterations (p<0.001). Depression was more frequent in women with anxiety (OR=4.2) and insomnia (OR=4.9), having a job being a protection factor (OR=0.2). Risk factors related to anxiety were the presence of depression (OR=6.1) and antecedents of pre-menstrual tension (OR=7.0). CONCLUSIONS: the prevalence of depression and anxiety is high in climacterium, being possible to detect risk factors related to their occurrence.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(12):614-619
DOI 10.1590/S0100-72032008001200005
PURPOSE: This paper has aimed at estimating the prevalence of infections by Chlamydia trachomatis and by Neisseria gonorrhoeae in pregnant women from six Brazilian cities, identifying its association with socio-economical and demographic variables. METHODS: This study has been part of a multicentric nationwide transversal research, with samples of pregnant women attended from 2004 to 2005 in basic attention pre-natal services from six Brazilian cities (Manaus, Fortaleza, Goiânia, Rio de Janeiro, São Paulo and Porto Alegre). Cervico-vaginal samples have been collected from all the pregnant women, and have afterwards been submitted to the hybrid capture technique in order to identify chlamydia and gonococcus. Socio-demographic, medical, sexual and obstetric information have been collected through specific questionnaires. The Odds Ratio (OR) has been used to evaluate risk factors associated to infection by gonorrhea and chlamydia. Statistical analysis has been done with the t-Student, χ2 and Fisher's exact tests. RESULTS: Three thousand and three pregnant women with an average age of 23.8 years old (±6.9) took part in the study. Infection prevalence by chlamydia and gonococcus were 9.4 and 1.5, respectively. Ten per cent of the pregnant women with chlamydia have presented gonococcus simultaneously. The risk of presenting one of those infections was two times higher for the women under 20. The infection main predictors have been: age under 20, race/black, single/separated and report of over one partner in the previous year. CONCLUSIONS: This study has observed high prevalence of infection by Chlamydia trachomatis and by Neisseria gonorrhoeae in Brazilian pregnant women. The main risk factor for the infection has been to be under 20 years old.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(6):274-280
DOI 10.1590/S0100-72032008000600002
PURPOSE: to assess the prevalence of group B streptococcus colonization (GBS) in pregnant women in prodrome or in labor. METHODS: vaginal and rectal cultures were collected from 201 pregnant women, in the admission sector of a public maternity center in the northeast region of Brazil (São Luís, Maranhão). The samples obtained were inoculated in a Todd-Hewith's selective culture medium and after that they were sub-cultivated in blood-agar plates. The CAMP (Christie, Atkins, Munch-Petersen) test was used to identify GBS, which was then serologically confirmed by the BioMérieux Api 20 Strep kit microtest. GBS positive samples were submitted to an antibiotic sensitivity test. Sociodemographic variables, gynecological-obstetrical antecedents, and perinatal outcomes were studied. The Epi-Info 3.3.2 programs from World Health Organization and Statistical Package for Social Sciences 14.0 version were used for the statistical analysis. The prevalence ratio was used as risk measure, considering p<0.05 as significance level, and accepting 80% power. RESULTS: the prevalence of SGB colonization in the mothers was 20.4%. There was no association between the sociodemographic variables or gynecological-obstetrical antecedents and a larger presence of SGB colonization. There were two cases of infectious outbreak among neonatal babies from colonized mothers, but hemocultures resulted negative. High resistance rates were found for the following antibiotics: clindamycin, 25.4%; erythromycin, 23.4% and ceftriaxone, 12.7%. CONCLUSIONS: the prevalence of SGB colonization was high among the mothers, similar to what had been described in other studies. The elevated rates of antimicrobial resistance, especially to ceftriaxone indicate the need for further studies to determine the serology of this agent and of orientation protocols for rational use of antimicrobials.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(5):235-240
DOI 10.1590/S0100-72032007000500003
PURPOSE: to establish the prevalence of thrombophilic factors in infertile women. METHODS: a cross-sectional study was performed, in which infertile women, seen in a private clinic with investigation for thrombophilia were included, according to the protocol of the clinic, between March 2003 and March 2005, after the approval of the Research Ethics Committee of the Universidade Estadual de Campinas (UNICAMP). One hundred and forty-four infertile women without any liver disease were evaluated. Infertility is defined as one year of unprotected sexual intercourse without conception. The acquired and/or inherited thrombophilic factors investigated were: anticardiolipin antibody (aCL), lupus anticoagulant (LA), protein C deficiency (PCD), protein S deficiency (PSD), antithrombin III deficiency (ATD), presence of the factor V Leiden, mutation G20 210A in the prothrombin gene, and C677T mutation of methylene tetrahydrofolate reductase (MTHFR). RESULTS: the prevalence values obtained for aCL and LA were 2%. The prevalence of the hereditary thrombophilic factors were: PCD=4%, PSD=6%, ATD=5%, factor V Leiden=3%, prothrombin mutation=3%, MTHFR mutation=57%. Conclusions: of the 144 patients selected, 105 women (72.9%) presented at least one thrombophilic factor. This reinforces the importance and justifies the need of investigation in this group.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(12):733-740
DOI 10.1590/S0100-72032006001200008
Chronic pelvic pain is a debilitating and highly prevalent disease with a major impact on quality of life and work productivity, beyond significant costs to health services. The dilemma of managing patients with chronic pelvic pain continues to frustrate physicians confronted with these complaints, in part because its pathophysiology is poorly understood. Consequently, its treatment is often unsatisfactory and limited to temporary symptom relief. In the present revision, we discuss the adequate management of chronic pelvic pain. We point out that a comprehensive medical history and physical examination should include special attention to gastrointestinal, urological, gynecological, muscle-skeletal, neurological, psychiatric, and endocrine systems. Thus, a multidisciplinary approach is recommended. Additionally, we emphasize that, although useful, specific surgical procedures, such as laparoscopy, should be indicated only to selected patients, mainly after excluding irritable bowel syndrome and pain of myofascial origin.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(3):171-178
DOI 10.1590/S0100-72032006000300006
PURPOSE: postpartum anxiety (PPA) is highly prevalent and has important consequences on mother and newborn. The aim of the present study was to estimate the prevalence of PPA and its risk factors, in a sample of women attending a private setting. METHODS: a cross-sectional study was performed with 299 women, at a routine gynecological visit, from August 2000 to May 2003. The Spielberger State-Trait Anxiety Inventory (STAIT) and a questionnaire with sociodemographic data and obstetric data were used. Inclusion criteria were: women with no past or present history of depression, psychiatric treatment, alcohol or drug abuse and whose children were alive. The prevalences of PPA-trace and PPA-state, that evaluate characteristics of personality and transitory anxiety, respectively, were estimated with 95% confiance intervals (CI). Odds ratios and 95% CI were used to examine the association between PPA and exposure variables. Hypothesis testing was done by the chi2 test or chi2 test for linear trend, when categories were ordered. A p value < 0.05 was considered to be statistically significant. RESULTS: the prevalences of PPA-state and PPA-trace were 44.8% (CI 95%: 39.1 - 50.7) and 46.1% (CI 95%: 40.4 - 52.0, respectively). Formal agreement between scales was moderate (kappa = 0.55; p<0.001). By univariate analysis, lower mother income and presence of newborn complications were associated with PPA-state and PPA-trace. Lower maternal age and greater number of alive children were associated with PPA-trace and PPA-state, respectively. By multivariate analysis, PPA-trace and PPA-state were associated with higher mother income (OR:0.39; IC 95%: 0.21 - 0.74, p=0,005; OR:0.46; IC 95%: 0.24 - 0.87, p=0.02) and presence of complications in newborns (OR:2.15; IC 95%: 1.02 - 4.54, p=0.04) (OR:2.47; IC 95%: 1.16 - 5.25, p=0.02), respectively. PPA-trace was associated with greater maternal age (OR:0.34; IC 95%: 0.13 - 0.88, p=0.008), while PPA-state was associated with greater number of alive children (OR:1.82; IC 95%: 1.01 - 3.29, p=0.04). CONCLUSIONS: PPA was highly prevalent in this sample of women attending a private setting. Higher mother income and greater maternal age decrease the risk of AP, while presence of complications in newborns and greater number of alive children increase the risk.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(10):575-579
DOI 10.1590/S0100-72032005001000002
PURPOSE: to verify the occurrence of colonization by Streptococcus agalactiae in pregnant women attended at the prenatal outpatient clinic of the Teaching Maternity Hospital of Rio de Janeiro University (UFRJ) and to evaluate the susceptibility of the isolates to antimicrobial agents. METHODS: a total of 167 pregnant women between the 32nd and 41st week of gestation, regardless of risk factors, attended at the antenatal clinic between February 2003 and February 2004, were evaluated. The vaginal/anal material, collected by the same swab, was inoculated in Todd-Hewitt broth to which nalidixic acid (15 µg/mL) and gentamicin (8 µg/mL) were added, with following subcultures onto sheep blood-agar. Identification was carried out observing colony morphology and beta-hemolysis type on blood-agar, catalase, cAMP, and serological tests. The antimicrobial susceptibility testing used agar diffusion and agar dilution methods. Statistical analysis was performed by the chi2 test with the level of significance set at p<0,05. RESULTS: the frequency of colonization was 19.2%, with no significant differences when age, number of gestations, number of abortions and the presence or absence of diabetes mellitus were compared (p>0.05). All 32 isolated strains were susceptible to penicillin, cefotaxime, ofloxacin, chloramphenicol, vancomycin and meropenem. Resistance to erythromycin and clindamycin was detected in 9.4 and 6.2% of the isolates, respectively. CONCLUSIONS: the relatively high incidence (19.2%) of colonization by S. agalactiae among the evaluated pregnant women and the recovery of antimicrobial resistant strains, especially those recommended in cases of penicillin allergy, emphasize the importance, for a correct prevention of neonatal infections, of detecting colonization at the end of pregnancy and evaluating antimicrobial susceptibility.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(4):181-188
DOI 10.1590/S0100-72032005000400004
PURPOSE: to estimate the prevalence of Family Health Program postpartum depression (PPD) and its association with minor mental disorders (MMD) among women attended in two (FHP) PSF units, in the city of São Paulo, and to identify risk factors associated with PPD. METHODS:a cross-sectional study with 70 postpartum women from two FHP units (Fazenda da Juta II and Jardim Sinhá), from October 2003 to February 2004. The following instruments were used: questionnaire with socio-demographical-economic data and obstetric and perinatal data; Self-Report Questionnaire 20 (SRQ-20), for screening of MMD, and Edinburgh Post-Natal Depression Scale (EPDS), for evaluation of PPD. To verify association between explanatory variables and PPD, Student's t test, chi2 or linear trend chi2 were utilized when indicated. To evaluate concordance between scales (EPDS and SRQ-20) kappa (kappa) coefficient correlation was used. RESULTS:the prevalence of PPD and MMD was 37.1%. Scales presented a good concordance (kappa=0.75). The explanatory variables age, ethnicity, years of education, profession, and marital status, besides partner's profession and years of education, familiar income, number of pregnancies, parity, miscarriage, number of alive children, premature deliveries, gestational age, type of delivery, planning of actual pregnancy, score of Apgar (first and five minutes), newborn sex and weight, and breastfeeding did not show significant statistical association. A greater perception of social support from the partner was associated with lower prevalence of PPD (p=0.03). CONCLUSION: because of its high prevalence and negative impact upon mother and child, it is worthwhile to sensitize health care professionals about the importance of PPD