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Trabalhos Originais
Glycosylated hemoglobin levels and cardiac abnormalities in fetuses of diabetic mothers
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(5):237-243
04-12-1998
Summary
Trabalhos OriginaisGlycosylated hemoglobin levels and cardiac abnormalities in fetuses of diabetic mothers
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(5):237-243
04-12-1998DOI 10.1590/S0100-72031998000500002
Views62We analyze prospectively the existence of a relationship between the mother's glycemic control, in the first half of pregnancy, and the occurrence of abnormal fetal cardiac abnormalities, in pregnant women with diabetes mellitus. In 127 pregnant women, the level of glycosylated hemoglobin was determined on the first visit during prenatal care. Nine patients had type I diabetes, 77 type II and 41 gestational diabetes mellitus (GDM). All mothers were submitted to detailed fetal echocardiography, during the 28th ± 4.127 week of gestation. In 31 (24.4%) of the 127 fetuses cardiac anomalies were detected. In 10 (7.87%) an isolated cardiac anomaly was identified. Mean HbA1c in the group of pregnant women without cardiac anomalies (5.64%) was statistically different from the group with anomalies (10.14%) (p<0.0001). The receiver-operator characteristic, representing the balance between sensitivity (92.83%) and specificity (98.92%) in the diagnosis of structural cardiac abnormalities, showed a cut-off point at the 7.5% HbA1c level. In nine of ten fetuses with structural cardiac anomalies, the maternal level of HbA1c was higher than 7.5%. The difference between means of the groups with and without myocardial hypertrophy diagnosed as isolated anomaly (MCHP) was not statistically significant, when considering both type II diabetes and GDM subgroups. In conclusion, levels of HbA1c higher than 7.5% were associated with most cases of echocardiographycally diagnosed structural cardiac anomalies. On the other hand, this test was not useful to discriminate conceptus with MCHP.
Key-words Diabetes mellitusFetusGlysosylated hemoglobin AMalformationsPregnancy complicationsUltrasonographySee moreViews62
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. Summary
Trabalhos OriginaisGlycosylated hemoglobin levels and cardiac abnormalities in fetuses of diabetic mothers
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(5):237-243
04-12-1998DOI 10.1590/S0100-72031998000500002
Views62We analyze prospectively the existence of a relationship between the mother's glycemic control, in the first half of pregnancy, and the occurrence of abnormal fetal cardiac abnormalities, in pregnant women with diabetes mellitus. In 127 pregnant women, the level of glycosylated hemoglobin was determined on the first visit during prenatal care. Nine patients had type I diabetes, 77 type II and 41 gestational diabetes mellitus (GDM). All mothers were submitted to detailed fetal echocardiography, during the 28th ± 4.127 week of gestation. In 31 (24.4%) of the 127 fetuses cardiac anomalies were detected. In 10 (7.87%) an isolated cardiac anomaly was identified. Mean HbA1c in the group of pregnant women without cardiac anomalies (5.64%) was statistically different from the group with anomalies (10.14%) (p<0.0001). The receiver-operator characteristic, representing the balance between sensitivity (92.83%) and specificity (98.92%) in the diagnosis of structural cardiac abnormalities, showed a cut-off point at the 7.5% HbA1c level. In nine of ten fetuses with structural cardiac anomalies, the maternal level of HbA1c was higher than 7.5%. The difference between means of the groups with and without myocardial hypertrophy diagnosed as isolated anomaly (MCHP) was not statistically significant, when considering both type II diabetes and GDM subgroups. In conclusion, levels of HbA1c higher than 7.5% were associated with most cases of echocardiographycally diagnosed structural cardiac anomalies. On the other hand, this test was not useful to discriminate conceptus with MCHP.
Key-words Diabetes mellitusFetusGlysosylated hemoglobin AMalformationsPregnancy complicationsUltrasonographySee moreThis 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. -
Trabalhos Originais
Prevention of preterm birth: use of digital examination and transvaginal ultrasonography
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(6):350-356
04-11-1998
Summary
Trabalhos OriginaisPrevention of preterm birth: use of digital examination and transvaginal ultrasonography
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(6):350-356
04-11-1998DOI 10.1590/S0100-72031998000600008
Views83See moreObjective: to evaluate the uterine cervix by digital and transvaginal ultrasound examinations in pregnant women at high risk of having premature delivery. Methods: during the period between February 1995 and September 1997, 38 pregnant women at high risk of having premature delivery between the 20th and 36th week of gestation were examined. These patients were submitted weekly to both digital and transvaginal ultrasound examinations. The digital examination evaluated the uterine cervix using two parameters: length and dilation. The transvaginal ultrasound studied the length and the anteroposterior diameter of the uterine cervix. The behavior of these cervical measurements was analyzed throughout the pregnancies. The two methods were compared regarding cervical evaluation and accuracy of premature birth diagnosis. Results: the rate of premature deliveries was 18.4% (7/38). Digital examination resulted in cervical evaluations with variation coefficients of 30.3% for length and 193% for dilation. Transvaginal ultrasound resulted in cervical evaluations with variation coefficients of 14.7% and 26.5% for the anteroposterior diameter and length, respectively. The cervical length measures obtained on ultrasound were always greater than those obtained on digital examination. Through analysis with the hypothesis test, an indirect relationship was observed between the cervical length and the gestational period for digital examination and ultrasound study (p<0.05 and p<0.01, respectively), and a direct relationship between the cervical dilation and the gestational age observed on the digital examination (p<0.01). Conclusions: among the parameters studied by means of the digital and transvaginal ultrasound examinations, the ultrasound cervical length presented the best accuracy in the diagnosis of premature birth, proving to be more reliable for the evaluation of cervical alterations in pregnant women at high risk of premature delivery.
Views83This 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. Summary
Trabalhos OriginaisPrevention of preterm birth: use of digital examination and transvaginal ultrasonography
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(6):350-356
04-11-1998DOI 10.1590/S0100-72031998000600008
Views83See moreObjective: to evaluate the uterine cervix by digital and transvaginal ultrasound examinations in pregnant women at high risk of having premature delivery. Methods: during the period between February 1995 and September 1997, 38 pregnant women at high risk of having premature delivery between the 20th and 36th week of gestation were examined. These patients were submitted weekly to both digital and transvaginal ultrasound examinations. The digital examination evaluated the uterine cervix using two parameters: length and dilation. The transvaginal ultrasound studied the length and the anteroposterior diameter of the uterine cervix. The behavior of these cervical measurements was analyzed throughout the pregnancies. The two methods were compared regarding cervical evaluation and accuracy of premature birth diagnosis. Results: the rate of premature deliveries was 18.4% (7/38). Digital examination resulted in cervical evaluations with variation coefficients of 30.3% for length and 193% for dilation. Transvaginal ultrasound resulted in cervical evaluations with variation coefficients of 14.7% and 26.5% for the anteroposterior diameter and length, respectively. The cervical length measures obtained on ultrasound were always greater than those obtained on digital examination. Through analysis with the hypothesis test, an indirect relationship was observed between the cervical length and the gestational period for digital examination and ultrasound study (p<0.05 and p<0.01, respectively), and a direct relationship between the cervical dilation and the gestational age observed on the digital examination (p<0.01). Conclusions: among the parameters studied by means of the digital and transvaginal ultrasound examinations, the ultrasound cervical length presented the best accuracy in the diagnosis of premature birth, proving to be more reliable for the evaluation of cervical alterations in pregnant women at high risk of premature delivery.
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. -
Trabalhos Originais
Diagnosis, Obstetrical Management and Perinatal Outcome in Hydrocephalus
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):381-387
04-09-1998
Summary
Trabalhos OriginaisDiagnosis, Obstetrical Management and Perinatal Outcome in Hydrocephalus
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):381-387
04-09-1998DOI 10.1590/S0100-72031998000700003
Views43See moreObjective: to evaluate the diagnosis, characteristics of pregnancy, maternal complications and perinatal outcome in cases of congenital hydrocephalus, and to associate them with pregnancy and delivery variables. Methods: 116 pregnancies with this diagnosis were evaluated before or after delivery, 112 of them occurring at the Maternity ward of CAISM/UNICAMP during the period between 1986 and 1995. For perinatal variables, complete data of 82 newborns were used. For data analysis, distributions and means were calculated and c² and Fisher exact tests were applied. Results: generally the diagnosis was made before delivery, confirmed by ultrasound and the delivery was through a cesarean section in cases. Cephalocentesis was performed in 11 cases and complications were more frequent in vaginal delivery than cesarean section. Low Apgar scores were more frequent among newborn babies delivered vaginally. Congenital hydrocephalus was also associated with important neonatal and perinatal morbidity and mortality, with other malformations, and a very low number of children without sequelae. Conclusions: the evaluation of these factors may be of great value for the obstetrician who is following pregnant women with this fetal malformation. This could better support the decisions that, although medical and ethical, should take into account the risk-benefit ratio of measures to be taken.
Views43This 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. Summary
Trabalhos OriginaisDiagnosis, Obstetrical Management and Perinatal Outcome in Hydrocephalus
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):381-387
04-09-1998DOI 10.1590/S0100-72031998000700003
Views43See moreObjective: to evaluate the diagnosis, characteristics of pregnancy, maternal complications and perinatal outcome in cases of congenital hydrocephalus, and to associate them with pregnancy and delivery variables. Methods: 116 pregnancies with this diagnosis were evaluated before or after delivery, 112 of them occurring at the Maternity ward of CAISM/UNICAMP during the period between 1986 and 1995. For perinatal variables, complete data of 82 newborns were used. For data analysis, distributions and means were calculated and c² and Fisher exact tests were applied. Results: generally the diagnosis was made before delivery, confirmed by ultrasound and the delivery was through a cesarean section in cases. Cephalocentesis was performed in 11 cases and complications were more frequent in vaginal delivery than cesarean section. Low Apgar scores were more frequent among newborn babies delivered vaginally. Congenital hydrocephalus was also associated with important neonatal and perinatal morbidity and mortality, with other malformations, and a very low number of children without sequelae. Conclusions: the evaluation of these factors may be of great value for the obstetrician who is following pregnant women with this fetal malformation. This could better support the decisions that, although medical and ethical, should take into account the risk-benefit ratio of measures to be taken.
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. -
Relato de Caso
Complete Mole in Twin Pregnancy: a Case Report
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):415-419
04-09-1998
Summary
Relato de CasoComplete Mole in Twin Pregnancy: a Case Report
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):415-419
04-09-1998DOI 10.1590/S0100-72031998000700008
Views57Twin pregnancy in which a normal fetus and a complete mole develop at the same time is a rare event. Clinical complications and malignancy are frequent in this type of disease.This report is about a case of a late diagnosis due to the presence of the fetus. The diagnosis was made when the pregnancy was interrupted and then confirmed by histopathological study and flow cytometry. The pregnancy was terminated transpelvically due to massive uterine hemorrhage. The post-molar follow-up showed the persistence of high levels of bhCG. The patient's complete recovery was achieved after the administration of methotrexate. The diagnosis, natural history, and procedures for this rare disease are discussed in view of this case.
Key-words ChemotherapyComplete hydatidiform moleGestational trophoblastic diseaseHemorrhagePregnancy complicationsTwin pregnancyUltrasonographySee moreViews57This 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. Summary
Relato de CasoComplete Mole in Twin Pregnancy: a Case Report
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):415-419
04-09-1998DOI 10.1590/S0100-72031998000700008
Views57Twin pregnancy in which a normal fetus and a complete mole develop at the same time is a rare event. Clinical complications and malignancy are frequent in this type of disease.This report is about a case of a late diagnosis due to the presence of the fetus. The diagnosis was made when the pregnancy was interrupted and then confirmed by histopathological study and flow cytometry. The pregnancy was terminated transpelvically due to massive uterine hemorrhage. The post-molar follow-up showed the persistence of high levels of bhCG. The patient's complete recovery was achieved after the administration of methotrexate. The diagnosis, natural history, and procedures for this rare disease are discussed in view of this case.
Key-words ChemotherapyComplete hydatidiform moleGestational trophoblastic diseaseHemorrhagePregnancy complicationsTwin pregnancyUltrasonographySee moreThis 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. -
Trabalhos Originais
Arterial doppler velocimetry in pregnant women with previous idiopathic intrauterine growth retardation
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):517-524
04-09-1998
Summary
Trabalhos OriginaisArterial doppler velocimetry in pregnant women with previous idiopathic intrauterine growth retardation
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):517-524
04-09-1998DOI 10.1590/S0100-72031998000900005
Views125See morePurpose: to determine the behavior of doppler velocimetry during the course of risk pregnancies and to compare the perinatal results obtained for concepti with retarded intrauterine growth (RIUG) with those for concepti considered adequate for gestational age (AGA). Methods: a prospective study of the evolution of doppler ultrasound was made in 38 pregnant women with of idiopathic intrauterine growth retardation (IUGR) in previous pregnancy. A relationship was established between this antecedent and the new pregnancy. The pregnant women studied were divided into two groups in agreement with their neonates birthweight. Group 1 was associated with IUGR and group 2 with adequate birth weight. IUGR was confirmed in 23.7% of the cases. Umbilical and uterine artery doppler velocimetry was performed from 20 to 40 weeks of gestation. Middle cerebral artery doppler velocimetry was analyzed after 28 weeks of gestation, twice a month, being the last valued examination before birth. Results: the uterine and umbilical artery ratio at 24 and 28 weeks of gestation, respectively, correlated with the presence of IUGR. There was no difference between the two groups regarding the presence or absence of a small notch in the uterine artery wave form and middle cerebral artery doppler velocimetry ratio, at the last examination before birth. There was a relationship between neonatal stay in hospital for more than three days and the presence of IUGR. Conclusions: doppler ultrasound should be used in the follow-up of cases with a high risk of IUGR. It allows the detection of the fetuses at high risk of hypoxia and, by interrupting the pregnancy, fetal distress-related complications may be avoided.
Views125This 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. Summary
Trabalhos OriginaisArterial doppler velocimetry in pregnant women with previous idiopathic intrauterine growth retardation
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):517-524
04-09-1998DOI 10.1590/S0100-72031998000900005
Views125See morePurpose: to determine the behavior of doppler velocimetry during the course of risk pregnancies and to compare the perinatal results obtained for concepti with retarded intrauterine growth (RIUG) with those for concepti considered adequate for gestational age (AGA). Methods: a prospective study of the evolution of doppler ultrasound was made in 38 pregnant women with of idiopathic intrauterine growth retardation (IUGR) in previous pregnancy. A relationship was established between this antecedent and the new pregnancy. The pregnant women studied were divided into two groups in agreement with their neonates birthweight. Group 1 was associated with IUGR and group 2 with adequate birth weight. IUGR was confirmed in 23.7% of the cases. Umbilical and uterine artery doppler velocimetry was performed from 20 to 40 weeks of gestation. Middle cerebral artery doppler velocimetry was analyzed after 28 weeks of gestation, twice a month, being the last valued examination before birth. Results: the uterine and umbilical artery ratio at 24 and 28 weeks of gestation, respectively, correlated with the presence of IUGR. There was no difference between the two groups regarding the presence or absence of a small notch in the uterine artery wave form and middle cerebral artery doppler velocimetry ratio, at the last examination before birth. There was a relationship between neonatal stay in hospital for more than three days and the presence of IUGR. Conclusions: doppler ultrasound should be used in the follow-up of cases with a high risk of IUGR. It allows the detection of the fetuses at high risk of hypoxia and, by interrupting the pregnancy, fetal distress-related complications may be avoided.
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. -
Trabalhos Originais
Estimation of Fetal Weight: Comparison Between a Clinical Method and Ultrasonography
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(10):551-555
04-05-1998
Summary
Trabalhos OriginaisEstimation of Fetal Weight: Comparison Between a Clinical Method and Ultrasonography
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(10):551-555
04-05-1998DOI 10.1590/S0100-72031998001000002
Views46See morePurpose: to assess the validity of fetal weight estimation by a method based on uterine height -- Johnson's rule. Methods: one hundred and one pregnant women and their newborn children were studied. The fetal weight was estimated using an adaptation of Johnson's rule, which consists of the clinical application of a mathematical model to calculate the fetal weight based on the uterine height and the height of fetal presentation. The estimated weight was obtained on the day of delivery and was compared to the weight observed after birth. This, in turn, was the control of the analysis of validity of the method used. On the same date, a detailed obstetrical ultrasonography (US) was conducted which included the fetal weight, calculated by the use of Sheppard's tables. This weight, estimated by US, was compared to the birth weight. Results: the results have proven that the clinical estimate used in this study has a similar value to that of the US calculation of birth weight. The accuracy of the clinical method, with variations of 5%, 10% and 15% between estimated and observed weights, was 55.3%, 73% and 86.7%, respectively. Those of the US were 60.7%, 75.4% and 91.1%, respectively. When comparing both sets of figures, values were not different from a statistical standpoint. Conclusion: the clinical evaluation has shown to be accurate, similarly to the US, when calculating the birth weight.
Views46This 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. Summary
Trabalhos OriginaisEstimation of Fetal Weight: Comparison Between a Clinical Method and Ultrasonography
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(10):551-555
04-05-1998DOI 10.1590/S0100-72031998001000002
Views46See morePurpose: to assess the validity of fetal weight estimation by a method based on uterine height -- Johnson's rule. Methods: one hundred and one pregnant women and their newborn children were studied. The fetal weight was estimated using an adaptation of Johnson's rule, which consists of the clinical application of a mathematical model to calculate the fetal weight based on the uterine height and the height of fetal presentation. The estimated weight was obtained on the day of delivery and was compared to the weight observed after birth. This, in turn, was the control of the analysis of validity of the method used. On the same date, a detailed obstetrical ultrasonography (US) was conducted which included the fetal weight, calculated by the use of Sheppard's tables. This weight, estimated by US, was compared to the birth weight. Results: the results have proven that the clinical estimate used in this study has a similar value to that of the US calculation of birth weight. The accuracy of the clinical method, with variations of 5%, 10% and 15% between estimated and observed weights, was 55.3%, 73% and 86.7%, respectively. Those of the US were 60.7%, 75.4% and 91.1%, respectively. When comparing both sets of figures, values were not different from a statistical standpoint. Conclusion: the clinical evaluation has shown to be accurate, similarly to the US, when calculating the birth weight.
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. -
Trabalhos Originais
Amniotic liquid index: study of inter- and intraobserver variability
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(8):443-448
04-05-1998
Summary
Trabalhos OriginaisAmniotic liquid index: study of inter- and intraobserver variability
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(8):443-448
04-05-1998DOI 10.1590/S0100-72031998000800003
Views126See morePurpose: to demonstrate the interobserver variation existing in the ultrasonographic measurement of amniotic fluid index (AFI) and in the measurement of pocket area, and to compare these two methods. In addition, an attempt was made to establish the intraobserver variation in the measurement of this index. Methods: values of AFI, described by Phelan et al.18, were studied in a group of 80 pregnant women considered to be clinically normal, seen at the Ultrasonography and Medical Updating School of Ribeirão Preto and in the Department of Gynecology and Obstetrics of the Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP). All pregnant women had a gestational age of more than 24 weeks. Fifty of these patients were submitted to AFI evaluation by 5 different ultrasonographists using the same equipment and during the same period of time, in order to determine the interobserver variation of this index. In addition, planimetric measurement of the area was performed by 2 of these 5 ultrasonographists, selected at random, in an attempt to determine interobserver variation in area measurement. Another group of 30 pregnant women was evaluated by the same ultrasonographist in an attempt to evaluate intraobserver variation in terms of AFI measurement. Results: There was a significant interobserver variation in AFI measurement and a significant variation in area measurement. However, the intraobserver variation in AFI measurement was nonsignificant. There was a correlation between AFI and area measurements. Conclusions: we emphasize the obstetrical applicability of this index and the easier execution of this method compared to area measurement, despite the importance of both procedures.
Views126This 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. Summary
Trabalhos OriginaisAmniotic liquid index: study of inter- and intraobserver variability
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(8):443-448
04-05-1998DOI 10.1590/S0100-72031998000800003
Views126See morePurpose: to demonstrate the interobserver variation existing in the ultrasonographic measurement of amniotic fluid index (AFI) and in the measurement of pocket area, and to compare these two methods. In addition, an attempt was made to establish the intraobserver variation in the measurement of this index. Methods: values of AFI, described by Phelan et al.18, were studied in a group of 80 pregnant women considered to be clinically normal, seen at the Ultrasonography and Medical Updating School of Ribeirão Preto and in the Department of Gynecology and Obstetrics of the Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP). All pregnant women had a gestational age of more than 24 weeks. Fifty of these patients were submitted to AFI evaluation by 5 different ultrasonographists using the same equipment and during the same period of time, in order to determine the interobserver variation of this index. In addition, planimetric measurement of the area was performed by 2 of these 5 ultrasonographists, selected at random, in an attempt to determine interobserver variation in area measurement. Another group of 30 pregnant women was evaluated by the same ultrasonographist in an attempt to evaluate intraobserver variation in terms of AFI measurement. Results: There was a significant interobserver variation in AFI measurement and a significant variation in area measurement. However, the intraobserver variation in AFI measurement was nonsignificant. There was a correlation between AFI and area measurements. Conclusions: we emphasize the obstetrical applicability of this index and the easier execution of this method compared to area measurement, despite the importance of both procedures.
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. -
Trabalhos Originais
Screening of breast cancer metastasis at preoperative work-up
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(8):475-479
04-05-1998
Summary
Trabalhos OriginaisScreening of breast cancer metastasis at preoperative work-up
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(8):475-479
04-05-1998DOI 10.1590/S0100-72031998000800008
Views95See morePurpose: to analyze the frequency of preoperative bilateral synchronic cancer and occult metastases in 454 operable breast cancer patients, at Instituto Nacional de Câncer (Brazil). Methods: the preoperative evaluation consisted of mammography, bone scan with X-ray if necessary, and chest X-ray. 260 (57.3 %) of 454 patients underwent liver echography. We calculated the cost X effectiveness ratio considering only the direct costs (monetary value) and the effectiveness was analyzed based on the number of metastases identifid by the screening tests. Results: we did not find any case of bilateral synchronic cancer, and the frequency of patients with metastasis was 2% (9/454). The diagnosis of bone metastasis was 1.5 % (7/454). The percentage of lung (2/454) and liver (1/260) metastasis was the same, 0.4 %. Most of the patients with metastases were in stage IIIb (44.5 %). The results of the screening tests showed the alteration of the initial clinical stage in 9 patients only (2%). The total cost of the screening tests for the diagnosis of systemic disease in 9 patients, was US$ 131,020.00. The cost of each diagnosed metastasise, for a total of 10 (two were found in one of the patients), was US$ 29,221.85 and the cost/effectiveness ratio was 22.3%. Conclusious: the results showed that screening for metastases in the preoperative clinical staging of breast cancer should be limited to patients symptomatic for systemic disease or in clinical stage III and that the cost/effectiveness ratio of the tests demonstrated a reduced benefit in the preoperative evaluation.
Views95This 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. Summary
Trabalhos OriginaisScreening of breast cancer metastasis at preoperative work-up
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(8):475-479
04-05-1998DOI 10.1590/S0100-72031998000800008
Views95See morePurpose: to analyze the frequency of preoperative bilateral synchronic cancer and occult metastases in 454 operable breast cancer patients, at Instituto Nacional de Câncer (Brazil). Methods: the preoperative evaluation consisted of mammography, bone scan with X-ray if necessary, and chest X-ray. 260 (57.3 %) of 454 patients underwent liver echography. We calculated the cost X effectiveness ratio considering only the direct costs (monetary value) and the effectiveness was analyzed based on the number of metastases identifid by the screening tests. Results: we did not find any case of bilateral synchronic cancer, and the frequency of patients with metastasis was 2% (9/454). The diagnosis of bone metastasis was 1.5 % (7/454). The percentage of lung (2/454) and liver (1/260) metastasis was the same, 0.4 %. Most of the patients with metastases were in stage IIIb (44.5 %). The results of the screening tests showed the alteration of the initial clinical stage in 9 patients only (2%). The total cost of the screening tests for the diagnosis of systemic disease in 9 patients, was US$ 131,020.00. The cost of each diagnosed metastasise, for a total of 10 (two were found in one of the patients), was US$ 29,221.85 and the cost/effectiveness ratio was 22.3%. Conclusious: the results showed that screening for metastases in the preoperative clinical staging of breast cancer should be limited to patients symptomatic for systemic disease or in clinical stage III and that the cost/effectiveness ratio of the tests demonstrated a reduced benefit in the preoperative evaluation.
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.
Ultrasonography Archives - Revista Brasileira de Ginecologia e Obstetrícia
