Treatment outcome Archives - Revista Brasileira de Ginecologia e Obstetrícia
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Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo46
, , , , , , Effective patient positioning is a critical factor influencing surgical outcomes, mainly in minimally invasive gynecologic surgery (MIGS) where precise positioning facilitates optimal access to the surgical field. This paper provides a comprehensive exploration of the significance of strategic patient placement in MIGS, emphasizing its role in preventing intraoperative injuries and enhancing overall surgical success. The manuscript addresses potential complications arising from suboptimal positioning and highlights the essential key points for appropriate patient positioning during MIGS, encompassing what the surgical team should or shouldn't do. In this perspective, the risk factors associated with nerve injuries, sliding, compartment syndrome, and pressure ulcers are outlined to guide clinical practice. Overall, this paper underscores the critical role of precise patient positioning in achieving successful MIGS procedures and highlights key principles for the gynecological team to ensure optimal patient outcomes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo46
, , , , , , Effective patient positioning is a critical factor influencing surgical outcomes, mainly in minimally invasive gynecologic surgery (MIGS) where precise positioning facilitates optimal access to the surgical field. This paper provides a comprehensive exploration of the significance of strategic patient placement in MIGS, emphasizing its role in preventing intraoperative injuries and enhancing overall surgical success. The manuscript addresses potential complications arising from suboptimal positioning and highlights the essential key points for appropriate patient positioning during MIGS, encompassing what the surgical team should or shouldn't do. In this perspective, the risk factors associated with nerve injuries, sliding, compartment syndrome, and pressure ulcers are outlined to guide clinical practice. Overall, this paper underscores the critical role of precise patient positioning in achieving successful MIGS procedures and highlights key principles for the gynecological team to ensure optimal patient outcomes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(6):274-277
DOI 10.1590/S0100-72032012000600006
PURPOSE: This study aimed to evaluate the results of neovaginoplasty by a modified McIndoe-Bannister technique and by the non-surgical Frank technique. METHODS: This retrospective study was conducted on a convenience sample of 25 women with vaginal agenesis undergoing surgical or conservative treatment at an Infant-Pubertal Gynecology Outpatient Clinic. Data were obtained from the medical records. Fifteen women underwent the surgical McIndoe-Bannister modified technique Surgical Group, and 10 women underwent the non-surgical Frank technique Frank Group. The following parameters were considered for comparative analysis between the two samples: vaginometry, surgical and non-surgical complications, and sexual satisfaction after treatment. Sexual satisfaction was assessed by a simple question: How is your sex life? RESULTS: There were differences related to vaginal length before and after performing exercises in both Frank Group (initial vaginal length 2.4±2.0 cm versus 6.9±1.1 cm after treatment, p<0.0001) and Surgical Group (initial vaginal length 0.9±1.4 cm versus 8.0±0.8 cm after treatment, p<0.0001). Increased vaginal length was observed in Surgical Group compared to Frank Group (Frank Group=7.0±0.9 cm versus Surgical Group=8.0±0.8 cm, p=0.0005). Forty percent of Surgical Group women had surgical complications versus no complications with the Frank technique. All women reported to be satisfied with their sexual life. CONCLUSION: The present data indicate that both the surgical and Frank techniques are effective for the treatment of vaginal agenesis, resulting in the construction of a vagina that pewrmits sexual intercourse and sexual satisfaction. The favorable aspects of the Frank technique are related to its low cost and to the low rates of major complications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(6):274-277
DOI 10.1590/S0100-72032012000600006
PURPOSE: This study aimed to evaluate the results of neovaginoplasty by a modified McIndoe-Bannister technique and by the non-surgical Frank technique. METHODS: This retrospective study was conducted on a convenience sample of 25 women with vaginal agenesis undergoing surgical or conservative treatment at an Infant-Pubertal Gynecology Outpatient Clinic. Data were obtained from the medical records. Fifteen women underwent the surgical McIndoe-Bannister modified technique Surgical Group, and 10 women underwent the non-surgical Frank technique Frank Group. The following parameters were considered for comparative analysis between the two samples: vaginometry, surgical and non-surgical complications, and sexual satisfaction after treatment. Sexual satisfaction was assessed by a simple question: How is your sex life? RESULTS: There were differences related to vaginal length before and after performing exercises in both Frank Group (initial vaginal length 2.4±2.0 cm versus 6.9±1.1 cm after treatment, p<0.0001) and Surgical Group (initial vaginal length 0.9±1.4 cm versus 8.0±0.8 cm after treatment, p<0.0001). Increased vaginal length was observed in Surgical Group compared to Frank Group (Frank Group=7.0±0.9 cm versus Surgical Group=8.0±0.8 cm, p=0.0005). Forty percent of Surgical Group women had surgical complications versus no complications with the Frank technique. All women reported to be satisfied with their sexual life. CONCLUSION: The present data indicate that both the surgical and Frank techniques are effective for the treatment of vaginal agenesis, resulting in the construction of a vagina that pewrmits sexual intercourse and sexual satisfaction. The favorable aspects of the Frank technique are related to its low cost and to the low rates of major complications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(2):80-85
DOI 10.1590/S0100-72032012000200007
PURPOSE: To evaluate the clinical outcomes after a minimum period of 5 years of follow-up of patients with abnormal uterine bleeding of benign etiology who underwent endometrial ablation, analyzing the success rate of treatment defined as patient satisfaction and improvement in uterine abnormal bleeding, as well as late complications and factors associated with recurrence of symptoms. METHODS: A cross-sectional survey was conducted after a minimum period of 5 years after surgery in patients who underwent the procedure between 1999 and 2004. We analyzed the following data: age at the time of surgery, immediate and late complications and associated factors. Logistic regression with Odds Ratio (OR) calculation was performed to evaluate possible associations between the success rate of surgery and the analyzed variables. RESULTS: A total of 114 patients underwent endometrial ablation between March 1999 and April 2004. The median follow-up was 82 months. The logistic regression model allowed the correct prediction of the success of endometrial ablation in 80.6% of cases. Age was directly related to the success of the procedure (OR=1.2; p=0.003) and previous tubal ligation showed a negative association with the success of endometrial ablation (OR=0.3; p=0.049). Among the patients with treatment failure, 21 (72.4%) underwent hysterectomy. In one of the hysterectomy cases, hydro/hematosalpinx was confirmed by the anatomopathological exam, characterizing the postablation-tubal sterilization syndrome. CONCLUSION: Endometrial ablation has proven to be a worthwhile treatment option, maintaining high rates of patient satisfaction, even over long-term follow-up. The age at endometrial ablation influenced the therapeutic success. Further studies are needed to evaluate the factors that may influence the future indication for the procedure in selected cases.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(2):80-85
DOI 10.1590/S0100-72032012000200007
PURPOSE: To evaluate the clinical outcomes after a minimum period of 5 years of follow-up of patients with abnormal uterine bleeding of benign etiology who underwent endometrial ablation, analyzing the success rate of treatment defined as patient satisfaction and improvement in uterine abnormal bleeding, as well as late complications and factors associated with recurrence of symptoms. METHODS: A cross-sectional survey was conducted after a minimum period of 5 years after surgery in patients who underwent the procedure between 1999 and 2004. We analyzed the following data: age at the time of surgery, immediate and late complications and associated factors. Logistic regression with Odds Ratio (OR) calculation was performed to evaluate possible associations between the success rate of surgery and the analyzed variables. RESULTS: A total of 114 patients underwent endometrial ablation between March 1999 and April 2004. The median follow-up was 82 months. The logistic regression model allowed the correct prediction of the success of endometrial ablation in 80.6% of cases. Age was directly related to the success of the procedure (OR=1.2; p=0.003) and previous tubal ligation showed a negative association with the success of endometrial ablation (OR=0.3; p=0.049). Among the patients with treatment failure, 21 (72.4%) underwent hysterectomy. In one of the hysterectomy cases, hydro/hematosalpinx was confirmed by the anatomopathological exam, characterizing the postablation-tubal sterilization syndrome. CONCLUSION: Endometrial ablation has proven to be a worthwhile treatment option, maintaining high rates of patient satisfaction, even over long-term follow-up. The age at endometrial ablation influenced the therapeutic success. Further studies are needed to evaluate the factors that may influence the future indication for the procedure in selected cases.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(1):5-9
DOI 10.1590/S0100-72032009000100002
PURPOSE: to evaluate factors related to the presence of neonatal macrosomia in pregnant women with gestational diabetes mellitus. METHODS: 157 pregnant women presenting gestational diabetes mellitus in follow-up were retrospectively selected from January 2004 to July 2006. This group has been divided into two subgroups: one with newborns with weight in accordance with the gestational age (n=136) and another with macrosomic newborns (n=21). Maternal characteristics have been compared between the groups. The t-Student test was used for the analysis of equality hypothesis between the averages of the two groups, and chi-square test, to check the groups' homogeneity concerning ratios. RESULTS: the groups did not show any significant difference concerning the gestational age, body mass index, weight gain along the gestation, number of previous pregnancies, fast glycemia in the oral glucose tolerance test after the ingestion of 75 g (TOTG 75 g), gestational age at delivery, glycemic values during the treatment, and the type of treatment used (p>0.05). In the group with neonatal macrosomia, there was a higher two-hour-glycemia in the TOTG 75 g (p=0.02), higher gestational age at the treatment onset (p=0.02), and a lower number of appointments at the health service (p<0.01). When adjusted to a logistic regression model, the most important factor (p<0.01) found to predict neonatal macrosomia was the two-hour-glycemia in the TOTG 75 g. CONCLUSIONS: the factors more frequently related to neonatal macrosomia were late treatment onset and, consequently, lower number of appointments and chiefly, high two-hour-glycemia in the TOTG 75 g.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(1):5-9
DOI 10.1590/S0100-72032009000100002
PURPOSE: to evaluate factors related to the presence of neonatal macrosomia in pregnant women with gestational diabetes mellitus. METHODS: 157 pregnant women presenting gestational diabetes mellitus in follow-up were retrospectively selected from January 2004 to July 2006. This group has been divided into two subgroups: one with newborns with weight in accordance with the gestational age (n=136) and another with macrosomic newborns (n=21). Maternal characteristics have been compared between the groups. The t-Student test was used for the analysis of equality hypothesis between the averages of the two groups, and chi-square test, to check the groups' homogeneity concerning ratios. RESULTS: the groups did not show any significant difference concerning the gestational age, body mass index, weight gain along the gestation, number of previous pregnancies, fast glycemia in the oral glucose tolerance test after the ingestion of 75 g (TOTG 75 g), gestational age at delivery, glycemic values during the treatment, and the type of treatment used (p>0.05). In the group with neonatal macrosomia, there was a higher two-hour-glycemia in the TOTG 75 g (p=0.02), higher gestational age at the treatment onset (p=0.02), and a lower number of appointments at the health service (p<0.01). When adjusted to a logistic regression model, the most important factor (p<0.01) found to predict neonatal macrosomia was the two-hour-glycemia in the TOTG 75 g. CONCLUSIONS: the factors more frequently related to neonatal macrosomia were late treatment onset and, consequently, lower number of appointments and chiefly, high two-hour-glycemia in the TOTG 75 g.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(6):294-299
DOI 10.1590/S0100-72032008000600005
PURPOSE: to verify the ratio of intra-uterine gestation in patients submitted to recanalization in the Hospital Regional da Asa Sul in the last 30 years and to assess the rate of ectopic gestation of such procedures, the influence of age and time interval between salpingectomy and recanalization in the therapeutic success. METHODS: medical files of 71 patients were analyzed, after exclusion of those presenting other alterations that could influence fertility prognosis, plus the cases when recanalization was impossible. Variables collected were: occurrence of intra-uterine gestation, coming to term or to abortion; occurrence of ectopic pregnancy after salpingectomy; no-conception after reversion, women's age at the recanalization, and time interval between salpingectomy and its reversion. RESULTS: there has been a pregnancy rate of 67.6%, 73.2% for bilateral recanalization and 46.6% for unilateral, as well as 5.6% of ectopic pregnancies. Concerning the patients' age group, it was observed a pregnancy rate of 33%, from 20 to 24; 60%, from 25 to 29; 69.2%, from 30 to 34; 65%, from 35 to 39, and 42.9%, from 40 to 44 years old. The number of cases was small for age the groups 20 to 24 and 40 to 44 years old. The time interval between salpingectomy and recanalization (TISR) has varied from one to 18 years. TISR has been divided in three groups presenting the following pregnancy rates: one to six year interval, 59%; seven to 12, 66.6%; 13 to 18, 57%. CONCLUSIONS: gestation rate has been 67.6%, 5.6% being ectopic. In the comparison of age groups, there has been no significant influence of age on the therapeutic success of patients from 25 to 39 years old. Sterility duration did not influence the reversion results.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(6):294-299
DOI 10.1590/S0100-72032008000600005
PURPOSE: to verify the ratio of intra-uterine gestation in patients submitted to recanalization in the Hospital Regional da Asa Sul in the last 30 years and to assess the rate of ectopic gestation of such procedures, the influence of age and time interval between salpingectomy and recanalization in the therapeutic success. METHODS: medical files of 71 patients were analyzed, after exclusion of those presenting other alterations that could influence fertility prognosis, plus the cases when recanalization was impossible. Variables collected were: occurrence of intra-uterine gestation, coming to term or to abortion; occurrence of ectopic pregnancy after salpingectomy; no-conception after reversion, women's age at the recanalization, and time interval between salpingectomy and its reversion. RESULTS: there has been a pregnancy rate of 67.6%, 73.2% for bilateral recanalization and 46.6% for unilateral, as well as 5.6% of ectopic pregnancies. Concerning the patients' age group, it was observed a pregnancy rate of 33%, from 20 to 24; 60%, from 25 to 29; 69.2%, from 30 to 34; 65%, from 35 to 39, and 42.9%, from 40 to 44 years old. The number of cases was small for age the groups 20 to 24 and 40 to 44 years old. The time interval between salpingectomy and recanalization (TISR) has varied from one to 18 years. TISR has been divided in three groups presenting the following pregnancy rates: one to six year interval, 59%; seven to 12, 66.6%; 13 to 18, 57%. CONCLUSIONS: gestation rate has been 67.6%, 5.6% being ectopic. In the comparison of age groups, there has been no significant influence of age on the therapeutic success of patients from 25 to 39 years old. Sterility duration did not influence the reversion results.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(6):331-339
DOI 10.1590/S0100-72032006000600003
PURPOSE: to evaluate the impact of supplementary ferrous sulfate and dietary counseling on hemoglobin levels in pregnant women. METHODS: a total of 197 pregnant women were evaluated during antenatal care at a health center. The treatment group consisted of 105 women who were prescribed 60 mg dietary iron per day, received dietary counseling and had hemoglobin measured by a portable photometer between the 14th and 20th week of pregnancy. The treatment group was reevaluated according to hemoglobin levels and food intake by a semiquantitative food frequency questionnaire after the 34th week of pregnancy. The control group consisted of 92 women in a cross-sectional study, at no less than 34 weeks of pregnancy. Hemoglobin was analyzed by a portable photometer and anemia was defined concentrations of less than 11 g/dL. All pregnant women had their weight and height measured. Hierarchical logistic regression model was developed for the multivariate analysis. RESULTS: prevalence of anemia at the end of the third trimester was 31.6% in the treatment group and 26.1% in the control group (p=0.43). Use of the prescribed supplement was reported by 65% of women in the treatment group, of which 67.7% interrupted the treatment at some point. Principal reasons for interrupting treatment were forgetting (43.2%) and nausea or vomiting (27.2%). Risk of anemia in the third trimester was three times higher in women with less than 8 years of schooling. CONCLUSIONS: use of ferrous sulfate was not shown to be associated with lower prevalence of anemia. The results suggest that structural changes in socioeconomic conditions are needed in order to alter the current situation regarding iron deficiency anemia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(6):331-339
DOI 10.1590/S0100-72032006000600003
PURPOSE: to evaluate the impact of supplementary ferrous sulfate and dietary counseling on hemoglobin levels in pregnant women. METHODS: a total of 197 pregnant women were evaluated during antenatal care at a health center. The treatment group consisted of 105 women who were prescribed 60 mg dietary iron per day, received dietary counseling and had hemoglobin measured by a portable photometer between the 14th and 20th week of pregnancy. The treatment group was reevaluated according to hemoglobin levels and food intake by a semiquantitative food frequency questionnaire after the 34th week of pregnancy. The control group consisted of 92 women in a cross-sectional study, at no less than 34 weeks of pregnancy. Hemoglobin was analyzed by a portable photometer and anemia was defined concentrations of less than 11 g/dL. All pregnant women had their weight and height measured. Hierarchical logistic regression model was developed for the multivariate analysis. RESULTS: prevalence of anemia at the end of the third trimester was 31.6% in the treatment group and 26.1% in the control group (p=0.43). Use of the prescribed supplement was reported by 65% of women in the treatment group, of which 67.7% interrupted the treatment at some point. Principal reasons for interrupting treatment were forgetting (43.2%) and nausea or vomiting (27.2%). Risk of anemia in the third trimester was three times higher in women with less than 8 years of schooling. CONCLUSIONS: use of ferrous sulfate was not shown to be associated with lower prevalence of anemia. The results suggest that structural changes in socioeconomic conditions are needed in order to alter the current situation regarding iron deficiency anemia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(10):613-618
DOI 10.1590/S0100-72032005001000008
PURPOSE: to evaluate the results of 14 cases of laparoscopic surgical treatment of patients with deep endometriosis of the rectovaginal septum in the Sector of Gynecological Endoscopy of the 'Hospital do Servidor Público Estadual "Francisco Morato de Oliveira"'. METHODS: a retrospective analysis was accomplished with data from the records, associated with postoperative evaluation of the patients operated between February 2002 and February 2004. The patients' age varied from 33 to 44 years, with a mean of 38.4. The parity ranged from 0 to 3, with a mean of 1.1. The main preoperative symptoms were: dysmenorrhea in 14 (100%), deep dyspareunia in 12 (85.7%), non-ciclic pelvic pain in 10 (71.4%), pain at defecation in two (14.3%), rectal bleeding in two (14.3%), and infertility in two (14.3%). The plasma level of CA-125 ranged from 3.6 to 100.3 U/mL, with a mean of 52.9 U/mL. RESULTS: the histological examination of the lesions of the rectovaginal septum was compatible with endometriosis in nine (64.3%) patients. Concerning painful symptoms, there was total regression in seven (50%) patients, partial regression (more than 80% relief) in two (14.3%), no improvement in four (28.6%), and worsening in one (7.1%). The incidence of complications was 14.3%: a ureter lesion associated with lesion of the sigmoid and a lesion of the rectum diagnosed on the 8th postoperative day. Conclusion: it can be concluded that endometriosis of the rectovaginal septum can be treated through laparoscopic surgery with low morbidity, leading to a complete or almost complete relief of the symptoms in most of the patients.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(10):613-618
DOI 10.1590/S0100-72032005001000008
PURPOSE: to evaluate the results of 14 cases of laparoscopic surgical treatment of patients with deep endometriosis of the rectovaginal septum in the Sector of Gynecological Endoscopy of the 'Hospital do Servidor Público Estadual "Francisco Morato de Oliveira"'. METHODS: a retrospective analysis was accomplished with data from the records, associated with postoperative evaluation of the patients operated between February 2002 and February 2004. The patients' age varied from 33 to 44 years, with a mean of 38.4. The parity ranged from 0 to 3, with a mean of 1.1. The main preoperative symptoms were: dysmenorrhea in 14 (100%), deep dyspareunia in 12 (85.7%), non-ciclic pelvic pain in 10 (71.4%), pain at defecation in two (14.3%), rectal bleeding in two (14.3%), and infertility in two (14.3%). The plasma level of CA-125 ranged from 3.6 to 100.3 U/mL, with a mean of 52.9 U/mL. RESULTS: the histological examination of the lesions of the rectovaginal septum was compatible with endometriosis in nine (64.3%) patients. Concerning painful symptoms, there was total regression in seven (50%) patients, partial regression (more than 80% relief) in two (14.3%), no improvement in four (28.6%), and worsening in one (7.1%). The incidence of complications was 14.3%: a ureter lesion associated with lesion of the sigmoid and a lesion of the rectum diagnosed on the 8th postoperative day. Conclusion: it can be concluded that endometriosis of the rectovaginal septum can be treated through laparoscopic surgery with low morbidity, leading to a complete or almost complete relief of the symptoms in most of the patients.