Articles - Revista Brasileira de Ginecologia e Obstetrícia

Original Article06-27-2002

The Trial of Labor After one Cesarean Section
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(3):161-166

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Abstract
Original Article
The Trial of Labor After one Cesarean Section
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(3):161-166
DOI 10.1590/S0100-72032002000300003
Iracema de Mattos Paranhos Calderon,
Jacqueline Leite Frade,
Joelcio Francisco Abbade,
Carolina Prado Diniz,
Ivete Dalben,
Marilza Vieira Cunha Rudge
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Purpose: to study trial of labor (TOL) for vaginal birth after one previous cesarean section. Methods: this is a retrospective cohort study that included 438 pregnant women with one previous cesarean section and their 450 newborns. They were divided into two groups – with and without TOL. The minimum sample size was 121 pregnant mothers per group. TOL was considered as an independent variable and vaginal birth and maternal and perinatal complication frequency as dependent variables. Both univariate and multivariate analyses were performed. The comparison of observed frequencies (%) was analyzed by the chi-squared test (chi²) with 5% significance, and linear regression from the odds ratio (OR) and confidence interval of 95% (CI95%). Results: TOL was used in 59.2% of vaginal deliveries. It was less used in women over 40 years (2.7% vs 6.7%) and in those with clinical or obstetrical diseases such as arterial hypertension (7.0%) and bleeding in the third trimester (0.3%). There was a higher risk for puerperal complications with cesarean deliveries (OR = 3.53, CI 95% = 1.57-7.93), independent of TOL. Perinatal mortality was dependent on neonatal weight and fetal malformations, not on TOL. Newborns from mothers not submitted to TOL were at a higher risk for developing breathing complications (OR = 1.92 CI 95% = 1.20-3.07). Conclusions: The results confirm that trial of labor after a previous cesarean section is a safe method – assisting vaginal delivery in 59.2% of births and not interfering with maternal and perinatal mortality. It is a treatment that should be stimulated.

Key-words Maternal and perinatal complications Previous cesarean section Trial of labor
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DECLARAÇÃO DE BARCELONA
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(3):151-151

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Abstract
DECLARAÇÃO DE BARCELONA
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(3):151-151
DOI 10.1590/S0100-72032002000300001
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DECLARAÇÃO DE BARCELONA […]
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A Grande Vitória
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):07-07

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Abstract
A Grande Vitória
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):07-07
DOI 10.1590/S0100-72032002000100001
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A Grande Vitória[…]
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Original Article06-20-2002

Microinvasive Carcinoma in the Cone Specimen in Women With Colposcopically Directed Biopsy Suggesting CIN 3
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):37-43

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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 Article
Microinvasive Carcinoma in the Cone Specimen in Women With Colposcopically Directed Biopsy Suggesting CIN 3
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):37-43
DOI 10.1590/S0100-72032002000100006
Priscila Garcia Figueiredo,
Renata Clementino Gontijo,
Sophie Françoise Mauricette Derchain,
Fabiana Yumi Nakano,
Julio César Teixeira,
Edson Zangiacomi Martinez
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Purpose: to determine the factors associated with the detection of a microinvasive carcinoma in the cervical cone of women with a previous colposcopically directed biopsy compatible with cervical intraepithelial neoplasia (CIN) 3 and to evaluate the proportion of involved margins. Patients and methods: we reviewed the medical records of 385 women (mean age: 39 years) submitted to cold conization or conization by high frequency surgery (HFS) with a loop during the period from January 1993 to July 2000. These procedures were indicated on the basis of a biopsy compatible with (CIN) 3. Results: the diagnosis of the cone was compatible with (CIN) 3 in 243 (63%) women and with (CIN) 2 in 13 (3%). Only 10 presented HPV/CIN 1 (3%) and eight had no residual disease in the cone. However, 101 (26%) women presented a microinvasive carcinoma in the cone and 10 (3%) presented a frankly invasive carcinoma. Age, menstrual status and number of deliveries were not related to the severity of the cone lesion. Women with oncologic colpocytology changes suggestive of invasion presented a significantly higher risk of having a microinvasive or invasive carcinoma as determined by final histology (p<0.01), although 52 of the 243 women with CIN 2 or CIN 3 in the cone also showed a suggestion of invasion at colpocytology. Among the women with CIN 2 or 3, the epithelium was white in 44%, dotted in 21%, and mosaic-like in 17%. This proportion was similar for women with a microinvasive or invasive carcinoma, with these images being detected in 37%, 23% and 21% of the cases, respectively. Involvement of the cone margins was significantly higher among women submitted to HFS (49%) than among those submitted to cold conization (29%). Conclusion: the absence of independent clinical and colposcopic factors associated with the detection of a microinvasive carcinoma in women submitted to conization on the basis of a biopsy compatible with (CIN) 3 justifies the conical excision of the squamocolumnar junction in high grade cervical lesions.

Key-words Carcinoma, microinvasive Colposcopy Conization Intraepithelial neoplasia
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Erratum06-19-2002
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1)

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Abstract
Erratum
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1)
DOI 10.1590/S0100-72032002000100018
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Associação entre a incisura Diastólica das artérias uterinas e a histologia do leito placentário em grávidas com pré-eclâmpsia […]
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Resumos de Teses06-19-2002

Contribuição ao Estudo do Laser de Vapor de Cobre no Tratamento da Endometriose Induzida Cirurgicamente em Coelhas
- Maurício Paulo Angelo Mieli
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):71-71

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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
Resumos de Teses
Contribuição ao Estudo do Laser de Vapor de Cobre no Tratamento da Endometriose Induzida Cirurgicamente em Coelhas
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):71-71
DOI 10.1590/S0100-72032002000100017
Maurício Paulo Angelo Mieli
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Contribuição ao Estudo do Laser de Vapor de Cobre no Tratamento da Endometriose Induzida Cirurgicamente em Coelhas […]
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Resumos de Teses06-19-2002

Avaliação do Potencial de Peroxidação Lipídica no Fluido Peritoneal de Mulheres Inférteis com Endometriose Pélvica
- Vivian Ferreira do Amaral
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):70-70

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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
Resumos de Teses
Avaliação do Potencial de Peroxidação Lipídica no Fluido Peritoneal de Mulheres Inférteis com Endometriose Pélvica
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):70-70
DOI 10.1590/S0100-72032002000100016
Vivian Ferreira do Amaral
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Avaliação do Potencial de Peroxidação Lipídica no Fluido Peritoneal de Mulheres Inférteis com Endometriose Pélvica […]
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Resumos de Teses06-19-2002

Prevalência das Neoplasias Intra-epiteliais Cervicais e Lesões Induzidas pelo HPV nas Mulheres Soropositivas/AIDS
- Susana Cristina Aidé Viviani Fialho
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):70-70

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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
Resumos de Teses
Prevalência das Neoplasias Intra-epiteliais Cervicais e Lesões Induzidas pelo HPV nas Mulheres Soropositivas/AIDS
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):70-70
DOI 10.1590/S0100-72032002000100015
Susana Cristina Aidé Viviani Fialho
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Prevalência das Neoplasias Intra-epiteliais Cervicais e Lesões Induzidas pelo HPV nas Mulheres Soropositivas/AIDS […]
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FEBRASGO POSITION STATEMENT05-16-2025

Mayer-Rokitansky-Kuster-Hauser syndrome
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-FPS4

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Abstract
FEBRASGO POSITION STATEMENT
Mayer-Rokitansky-Kuster-Hauser syndrome
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-FPS4
DOI 10.61622/rbgo/2025FPS4
Claudia Cristina Takano Novoa ,
Mila Torii Correa Leite ,
Marair Gracio Ferreira Sartori
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Key points

•Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) is the leading cause of vaginal agenesis.

•It is characterized by primary amenorrhea with typical adrenarche and telarche and may be associated with congenital urological and skeletal conditions that should be investigated.

•Differential diagnoses include: vaginal obstructions (imperforate hymen, distal vaginal atresia, transverse vaginal septum), uterine obstructions (cervical atresia), and differences in sexual development (gonadal dysgenesis, complete androgen insensitivity and congenital adrenal hyperplasia due to CYP17 deficiency).

•Laboratory tests (testosterone, follicle-stimulating hormone [FSH] and karyotype) and radiological tests (pelvic ultrasound and MRI) are necessary.

•Vaginal dilation is the first line of treatment with high success rates.

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Original Article04-30-2025

Depression, anxiety, sexual function and quality of life in women with hyperprolactinemia
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo7

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Abstract
Original Article
Depression, anxiety, sexual function and quality of life in women with hyperprolactinemia
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo7
DOI 10.61622/rbgo/2025rbgo7
Renan Massao Nakamura ,
Daniela Angerame Yela ,
Amanda Carvalho Santos ,
Beatriz Cipriano Ribas ,
Pedro Henrique Silva Rosa e ,
Bianca Netto Motta ,
Gabriela Pravatta Rezende ,
Cristina Laguna Benetti-Pinto
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Abstract

Objective:

To evaluate anxiety, depression, sexual function and quality of life in women with hyperprolactinemia.

Methods:

Cross-sectional study with 80 women divided into two groups: 30 women with hyperprolactinemia (Study Group) followed and treated at the endocrine gynecology outpatient clinic and 50 women without hyperprolactinemia, with regular menstrual cycles (Control Group) followed at the family planning outpatient clinic of the State University of Campinas from June 2021 to October 2022. Sociodemographic characteristics, quality of life (SF-36 Questionnaire), sexual function (Female Sexual Function Index Questionnaire), depression (Beck Depression Inventory) and anxiety (Beck Anxiety Scale) were evaluated in both groups. Categorical variables were described as absolute frequency and percentage; numerical variables as mean and standard deviation. Comparison of numerical variables between two groups was performed by Mann-Whitney test, while categorical were compared by Chi-Square or Fisher’s exact tests.

Results:

The mean age of women with hyperprolactinemia was 39.6±8.1 years and the Control Group was 31.2±9.5 years (p<0.001). There was no difference in anxiety scores (p=0.66), depression (p=0.08) and general sexual function (p=0.08) in both groups. However, women with hyperprolactinemia had lower scores in the domains of pain and arousal and worse functional capacity than Control Group (p<0.05).

Conclusion:

Women with hyperprolactinemia under treatment do not show any impairment in their anxiety, depression and sexual function when compared to women without hyperprolactinemia. However, analysis of quality of life showed that women with hyperprolactinemia have poor functional capacity.

Key-words Anxiety Depression Hyperpituitarism Hyperprolactinemia Quality of life sexual function surveys and questionnaires
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Original Article04-30-2025

Hysterectomy rates per resident in final year of training in teaching hospitals: an ecologic study
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo24

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Abstract
Original Article
Hysterectomy rates per resident in final year of training in teaching hospitals: an ecologic study
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo24
DOI 10.61622/rbgo/2025rbgo24
Luiza Nestori Chiozzotto ,
Nino José Wilson Moterani Júnior ,
Laura Bresciani Bento Gonçalves Moterani ,
Vinicius César Moterani ,
Francisco José Candido dos Reis
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Abstract

Objective:

Analyze the hysterectomy rates per resident in graduation year in teaching hospitals in the state of São Paulo (Brazil).

Methods:

We selected teaching hospitals in the state of São Paulo and gathered information from two public databases to estimate the hysterectomy rates per resident in their final year of training between 2009 and 2019.

Results:

Between 2009 and 2019, there was a 37.5% increase in the number of residents in their final year of training, a 4.31% increase in the number of hysterectomies, and a drop in the hysterectomy rates per resident of 24.1%. The reduction of the rate of hysterectomy per resident was more pronounced for vaginal route (46.4%) followed by abdominal route (23.3%). The ratio of laparoscopic hysterectomy per resident increased 264% during the period, however, this route was used in only 7% of the surgeries in 2019.

Conclusions:

The hysterectomy rates per resident in their final year of training showed a notable reduction. This trend, particularly pronounced in vaginal and abdominal routes, signals a shift towards minimally invasive techniques.

Key-words Clinical competence Education, medical Hospitals, teaching Hysterectomy learning curve Medical staff, hospital Physicians Students, medical Surgical procedures, operative
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Original Article04-30-2025

Prevalence of antiphospholipid syndrome among women with recurrent pregnancy loss: a cohort study
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo23

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Abstract
Original Article
Prevalence of antiphospholipid syndrome among women with recurrent pregnancy loss: a cohort study
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo23
DOI 10.61622/rbgo/2025rbgo23
Elaine Cristina Fontes de Oliveira ,
Daniel Dias Ribeiro ,
Janaína Campos Senra ,
Fernando Marcos dos Reis
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Abstract

Objective:

This study aimed to evaluate the prevalence of antiphospholipid syndrome (APS) among women experiencing recurrent pregnancy loss (RPL).

Methods:

A cross-sectional was conducted, reviewing the medical records of 134 women with a history of two or more miscarriages, treated between January 2014 and May 2024 at a tertiary university center in Belo Horizonte, Brazil. APS screening was performed by assessing anticardiolipin (IgG and IgM), lupus anticoagulant, and anti-β2-glycoprotein-1 (IgG and IgM) antibodies, based on Sapporo criteria. All tests were performed during non-pregnant periods and at least 12 weeks after the last miscarriage.

Results:

The study included 134 women with a mean age of 33.8 ± 5.7 years. The number of prior miscarriages ranged from 2 to 11 per couple. Among the patients who presented the lupus anticoagulant, only two (1.49%) tested positive in two samples, as per revised Sapporo criteria. Considering IgG and IgM anticardiolipin antibodies, four patients (2.98%) tested positive in two samples according to old Sapporo criteria, with one patient having a positive IgG test in two samples, two having positive IgM in two samples and a single patient having both positive tests. None of the 56 patients tested positive for anti-β2-glycoprotein-1 antibodies in two samples.

Conclusion:

The prevalence of antiphospholipid antibodies, in line with revised Sapporo criteria, is low among Brazilian women with recurrent pregnancy loss, consistent with recent studies in literature. Ensuring the appropriateness of diagnostic criteria is crucial to avoid unnecessary treatment with platelet anticoagulants and heparin in this population.

Key-words Abortion, habitual Abortion, spontaneous Antibodies Anticardiolipin Antiphospholipid syndrome Prevalence Thrombophilia
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Original Article04-30-2025

An assessment of total antioxidant and oxidant parameters and their correlation with embryo quality in in-vitro fertilization patients
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo22

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Abstract
Original Article
An assessment of total antioxidant and oxidant parameters and their correlation with embryo quality in in-vitro fertilization patients
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo22
DOI 10.61622/rbgo/2025rbgo22
Utkucan Okuducu ,
Gökhan Bayhan ,
Dilek Ulusoy Karatopuk
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Abstract

Objective:

In vitro, fertilization is the primary treatment method for infertility. Follicular fluid analysis is an approach used to optimize the results of assisted reproductive techniques. Oxidative stress represents the imbalance between the production of reactive oxygen species and their detoxification. Total Antioxidant and Oxidant Status, and Oxidative Stress Index levels are the main oxidative stress markers. This study investigated the effects of oxidative stress markers on infertility etiology, embryo quality, and success of In vitro fertilization.

Methods:

Before enrolling in the ICSI-ET cycle, participants had their FSH and LH levels assessed on the second day of the cycle. The ovarian degrees of the participants were evaluated by transvaginal ultrasonography. Participants underwent controlled ovarian stimulation using the GnRH antagonist protocol. TV-USG and serial E2 measurements were performed at appropriate intervals to follow follicular development. Follicle sizes, quantity, and endometrial thickness were recorded. Total Antioxidant and Oxidant Status, and Oxidative analyses were conducted using Rel Assay Diagnostics Assay Kits.

Results:

The average number of total oocytes in the participants was 10.25±6.66, and the average of mature M2 stage oocytes was 6.71±3.72. The average number of fertilized oocytes was 4.65±2.81. Fertilization rates were calculated as approximately 54.75±25.58%. A statistically significant positive correlation was found between embryo quality and serum Total Antioxidant Status levels (p=0.004). Similarly, a significant positive correlation was observed between embryo quality and follicular Total Antioxidant Status values (r = 0.42, p = 0.01).

Conclusion:

This study concluded that oxidative stress markers affect certain stages of the IVF treatment process.

Key-words Antioxidants Fertilization in vitro Follicular fluid Infertility Oocytes Oxidants Oxidative stress
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Review Article04-30-2025

Letrozole and clomiphene versus letrozole alone for ovulation induction in women with PCOS: a systematic review and meta-analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo21

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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
Review Article
Letrozole and clomiphene versus letrozole alone for ovulation induction in women with PCOS: a systematic review and meta-analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo21
DOI 10.61622/rbgo/2025rbgo21
Karine Eskandar ,
Juliana Almeida Oliveira ,
Sandro Augusto Ribeiro ,
Matheus Pedrotti Chavez ,
Ana Isabela de Araujo Zotti ,
Yasmin Jardim Meirelles Dias ,
Andrea Mora de Marco Novellino
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Abstract

Objective:

We aimed to compare the efficacy and safety of letrozole and clomiphene versus letrozole alone for ovulation induction in patients with Polycystic Ovary Syndrome (PCOS).

Data Sources:

We systematically searched EMBASE, PubMed, and Cochrane databases on October 31, 2024.

Study selection:

We included studies of women with PCOS treated with a combination of clomiphene and letrozole or letrozole alone to induce ovulation that reported any of the outcomes of interest, namely rate of mature follicles and ovulation, ovulation, pregnancy, miscarriages, endometrial thickness, and number of mature follicles.

Data collection:

We pooled odds ratios (OR) and mean difference (MD) with 95% confidence intervals (CI) using a random effects model using R statistical software, version 4.2.1. Heterogeneity was assessed with I statistics, and a random effects model was used.

Data Synthesis:

Four RCTs and two observational studies comprising 592 patients were included. Combined therapy was associated with a higher rate of a mature follicle (OR 2.74; 95% CI 1.72-4.37; p< 0.001; I=0%) and ovulation (OR 2.55; 95% CI 1.57-4.12; p< 0.001; I=35.9%). The number of mature follicles, number of pregnancies, thickness of endometrial lining, and the incidence of adverse events, including headache, abdominal bloating, fatigue, back pain, breast discomfort, and night sweats, were similar between groups.

Conclusion:

In women with anovulatory infertility secondary to PCOS, letrozole and clomiphene citrate combined therapy was associated with improved mature follicle and ovulation rates, with a similar safety profile compared to letrozole alone. However, no significant impact was observed on pregnancy rates.

Key-words Clomiphene Infertility, female Letrozole Ovulation Ovulation Induction Polycystic ovary syndrome
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Original Article04-30-2025

Incidence of small-for-gestational-age newborns in pregnant women with COVID-19
- Gustavo dos Santos Raupp ,
- Renato Teixeira Souza ,
- Maria Laura Costa ,
- Jose Guilherme Cecatti ,
- Annerose Barros ,
- Janete Vettorazzi
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo20

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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 Article
Incidence of small-for-gestational-age newborns in pregnant women with COVID-19
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo20
DOI 10.61622/rbgo/2025rbgo20
Gustavo dos Santos Raupp ,
Renato Teixeira Souza ,
Maria Laura Costa ,
Jose Guilherme Cecatti ,
Annerose Barros ,
Ellen Machado Arlindo ,
Edson Vieira Cunha Filho ,
Janete Vettorazzi
Views83
Abstract

Objective:

This study aimed to assess the incidence of small for gestational age (SGA) newborns in pregnant women infected with COVID-19 and examine the associated neonatal outcomes.

Methods:

This study involved a secondary analysis of the REBRACO Network, a prospective cohort study conducted in 15 maternity hospitals in Brazil before the introduction of COVID-19 vaccination (February 2020 to February 2021). Demographic data of pregnant women tested for COVID-19 were analyzed, and fetal outcomes were compared between women with positive and negative COVID-19 results who had SGA fetuses.

Results:

A total of 729 symptomatic pregnant women with COVID-19 were included in the study. However, there were 248 participants with missing information regarding childbirth or loss of follow-up, and 107 participants without confirmatory tests for COVID-19. Among the remaining participants, 198 had confirmed COVID-19 and 176 tested negative. The incidence of SGA among women with COVID-19 was 22.4%, whereas the incidence among women who tested negative for COVID-19 was 14.8%. SGA newborns born to COVID-19 positive pregnant women were 1.6 times more likely to experience adverse outcomes (such as prematurity, stillbirth, neonatal death, and admission to a neonatal ICU) compared to non-SGA newborns [OR = 1.655 (1.145 – 2.394); P=0.017]. In SGA newborns of pregnant women with confirmed COVID-19 infection, mechanical ventilation use was found to be associated with the infection [OR = 0.692 (0.562 – 0.853); P=0.002].

Conclusion:

The higher incidence of SGA newborns and its stronger association with prematurity in pregnant women with confirmed COVID-19 infection suggest that COVID-19 infection is a significant factor contributing to neonatal morbidity and mortality.

Key-words coronavirus infections COVID-19 Infant, newborn Infant, small for gestational age maternal health Pregnancy complications
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Review Article04-30-2025

Efficacy of tranexamic acid application in gynecology and obstetrics procedures: a umbrella review of systematic reviews of randomized trials
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo18

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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
Review Article
Efficacy of tranexamic acid application in gynecology and obstetrics procedures: a umbrella review of systematic reviews of randomized trials
Revista Brasileira de Ginecologia e Obstetrícia. 2025;47:e-rbgo18
DOI 10.61622/rbgo/2025rbgo18
Nicole Cristina Lottermann ,
Nathalia Luiza Andreazza ,
Matheus de Araújo Moura Cavalcante ,
Laura Andrade Fernandez ,
Carla Vitola Gonçalvez ,
Linjie Zhang
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Abstract

Objective:

This umbrella review aimed to synthesize evidence from systematic reviews of clinical trials on the efficacy of tranexamic acid in gynecology and obstetrics procedures.

Methods:

We searched Medline, Embase, SciELO and Cochrane Database of Systematic Reviews on March 11, 2024, using the term “tranexamic acid”. Four reviewers independently select studies and extract data. We assessed the quality of systematic review and the quality of evidence, using AMSTAR 2 and GRADE tools, respectively.

Results:

Of 651 systematic reviews identified, 16 reviews with 96663 patients were included. The surgical procedures were cesarean section, myomectomy, hysterectomy, and cervical intraepithelial neoplasia surgery. All reviews showed a statistically significant and clinically relevant reduction in intraoperative and post-procedure blood loss, associated with intravenous or topical use of tranexamic acid. Tranexamic acid resulted in a significant reduction in the need for blood transfusions and a less pronounced drop in postoperative hematocrit and hemoglobin levels in cesarean section. Several reviews addressed the same question, but the number of included trials varied substantially, which might indicate flaws in search and selection of studies of these reviews. The quality of systematic reviews was low or critically low, and the quality of evidence was moderate.

Conclusions:

This umbrella review shows that tranexamic acid can reduce blood loss and hemorrhage in gynecology and obstetrics procedures. High quality systematic reviews are still needed.

Key-words Blood transfusion Cesarean section Efficacy Gynecologic surgical procedures hematocrit Hemorrhage Hysterectomy Obstetric surgical procedures Tranexamic acid Uterine cervical dysplasia uterine myomectomy
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Original Article06-19-2002

Computerized Antepartum Cardiotocography Analysis in High Risk Pregnancies
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):29-36

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Abstract
Original Article
Computerized Antepartum Cardiotocography Analysis in High Risk Pregnancies
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):29-36
DOI 10.1590/S0100-72032002000100005
Roseli Mieko Yamamoto Nomura,
Rossana Pulcineli Vieira Francisco,
Débora Simões Steinman,
Seizo Miyadahira,
Marcelo Zugaib
Views106
Purpose: to study computerized cardiotocography performed in high-risk pregnancies, analyze the results, and correlate the criteria to perinatal results. Patients and Methods: two hundred and thirty-three high-risk pregnancies were studied prospectively, performing a total of 485 computerized cardiotocographies. The exclusion criteria included fetal anomalies and signal loss over 20% (proportion of 3.75-millisecond periods in which there were no valid pulse intervals). The perinatal results of 71 pregnancies were correlated to the last cardiotocography, performed at least seven days before birth, excluding patients with absent or reversed end diastolic velocities in the umbilical arteries. Results: thirty-three examinations with signal loss over 20% were excluded. The normal criteria were met in 404 (83.3%), and 62.1% examinations met the criteria within 20 minutes and 79% within 30 minutes. The abnormal computerized cardiotocography was related significantly (p<0.05) to adverse perinatal results, such as: preterm delivery, first minute Apgar score less than 7 (33%), neonatal intensive care admission (55.5%) and intubation of newborn at delivery (44.4%). Conclusions: computerized cardiotocography in high-risk pregnancies met the normal criteria in most of the cases, with the examination performed for 30 minutes. The cases that did not meet the criteria correlated significantly to adverse perinatal results.

Key-words Cardiotocography Fetal heart rate Fetal well-being
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Original Article06-19-2002

Predictive Model using Risk Factors for Cesarean Section
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):21-28

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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 Article
Predictive Model using Risk Factors for Cesarean Section
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):21-28
DOI 10.1590/S0100-72032002000100004
Alfredo de Almeida Cunha,
Margareth Crisóstomo Portela,
Abés Mahomed Amed,
Luiz Camano
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Purpose: to investigate antepartum factors related to cesarean section and develop a cesarean section predictive model. Methods: the study design was a retrospective cohort which included all the cared 843 deliveries in a third level unit from June 1993 through November 1994. Children with 1,000 g birthweight and above were included. The dependent variable was cesarean section (c-section). Independent variables were antepartum factors related to c-section. Logistic regression was used to develop a predictive model. Results: our model showed risk of c-section according to the following variables: maternal age under 20 years (OR = 0.396) and over 28 years (OR = 2.133); previous vaginal deliveries (OR = 0.626); previous c-section (OR = 4.576); prenatal care (OR = 2.346); breech presentation (OR = 4.174); twin pregnancies (OR = 14.065); late obstetrical hemorrhage (OR = 28.189); mild preeclampsia (OR = 2.180); severe preeclampsia OR=16.738; chronic hypertension OR=4.927 and other clinical problems (OR = 2.012). The predictive model had a concordance of 82.3% between probabilities and responses. Conclusions: our study identified 12 antepartum factors related to c-section. It was possible to develop a cesarean section predictive model taking into account all previously identified antepartum risk factors.

Key-words Cesarean section Delivery, mode of Predictive model Pregnancy complications
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Original Article06-19-2002

Maternal Morbidity and Perinatal Morbidity and Mortality Associated with Ascendant Infection in Premature Rupture of Membranes
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):15-20

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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 Article
Maternal Morbidity and Perinatal Morbidity and Mortality Associated with Ascendant Infection in Premature Rupture of Membranes
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):15-20
DOI 10.1590/S0100-72032002000100003
José Elias Soares da Rocha,
Ana Claire Pimenteira Tomaz,
Dinalva Bezerra da Rocha,
Antônio Fernando Bezerra,
Ana Luzia de Campos Lopes,
Ana Maria Omena Breda,
Silvia Danielle Alves Souza
Views68
Purpose: to evaluate the effects of ascending infection on the mother and newborn in the cases of premature rupture of membranes. Methods: this was a prospective study, carried out to evaluate 50 pregnant women with premature rupture of membranes (PROM) and their newborns. The clinical chorioamnionitis was investigated by clinical findings (thermal curve, abdominal pain by groping and/or uterine softening, smell and other characteristics of vaginal secretion) and subsidiary tests (white blood cell count and C-reactive protein). The histologic chorioamnionitis was investigated by macroscopic and microscopic study (placenta, membranes and cord). In the microscopic study optic microscopy with hematoxylin-eosin staining was used. The newborns were evaluated as to weight and Apgar score in the first and fifth minutes of life. White blood cell count, culture of auditory canal swab and aspirated gastric material culture complemented the study. Statistical analysis was performed using the Fisher exact test and the Student t-test, with level of significance set at 5% (p < 0.05). Results: The rate of clinical chorioamnionitis was 29.4% (15/50), while for histologic chorioamnionitis it was 40% (20/50). All the cases of clinical chorioamnionitis had latency times (LT) higher than 24 hours. The newborns presented signal of infection in 31.4% of the cases (16/51), all with LT higher than 24 hours. The main isolated microorganisms of auditive duct and gastric aspirate of newborns were Klebsiella pneumoniae, Staphylococcus aureus, Gram positive coccus and group B Streptococcus. The infected newborns presented lower Apgar scores in the first and fifth minute of life, lower weight and higher perinatal morbidity and mortality when compared with newborns without infection. Conclusions: based on the analysis of results obtained in the present study, it was possible to conclude that the prolonged latency times increase the possibility of ascending infection, leading to higher possibility of premature delivery and high maternal morbidity (clinical chorioamnionitis), as well as perinatal morbidity and mortality.

Key-words Ascending infection Chorioamnionitis Premature rupture of membranes
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Original Article06-19-2002

Maternal Serum Level of C-reactive Protein in Gestations Complicated by Preeclampsia
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):09-13

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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 Article
Maternal Serum Level of C-reactive Protein in Gestations Complicated by Preeclampsia
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):09-13
DOI 10.1590/S0100-72032002000100002
Antônio Carlos Vieira Cabral,
Janaína de Freitas Lázaro,
Zilma Nogueira Reis Vitral
Views67
Purpose: to investigate the association between serum C-reactive protein concentration and preeclampsia occurrence, as well as its relation to the disease severity. Patients and Methods: twenty-seven preeclamptic pregnant women and 27 pregnant women with no clinical intercurrences, in the third trimester of pregnancy, were evaluated in a transversal case-control study. Serum C-reactive protein dosage, besides clinical examination and laboratory tests for the diagnosis of the disease, were performed in the antenatal period. The association between C-reactive protein and the presence of preeclampsia, and the correlation between plasma protein values and blood pressure values were investigated. The chi² significance test and regression analysis through the square minimum technique were used, and the results were considered to be statistically significant when p<0.05. Results: the preeclamptic pregnant women presented mean blood pressure levels higher than their controls (129.9±12.1 and 87.2±6.5 mmHg, respectively) and significantly higher C-reactive protein mean values than the normotensive women (18.9±4.9 and 1.56±0.8 mg/L, respectively). There was a significant association between the C-reactive protein concentration increase and preeclampsia occurrence (p<0.0001, odds ratio: 20.1). It was also observed that the mean arterial pressure and proteinuria presented a direct correlation with the circulating C-reactive protein in maternal blood (p=0.001 and p<0.001, respectively). Conclusion: C-reactive protein is an effective marker of preeclampsia occurrence and significantly correlates with the disease severity. The use of this test for the differential diagnosis of pregnant women in several hypertensive situations and its utilization as a marker of preeclampsia prognosis deserve further studies.

Key-words C-reactive protein Hypertension Proteinuria
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Original Article06-18-2002

Correlation Between Laparoscopic Aspects and Histologic Findings in Peritoneal Endometriotic Lesions
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(2):93-99

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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 Article
Correlation Between Laparoscopic Aspects and Histologic Findings in Peritoneal Endometriotic Lesions
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(2):93-99
DOI 10.1590/S0100-72032002000200004
Francesco Antonio Viscomi,
Rogério Dias,
Laurival de Luca,
Mauro Fernando Kürten Ihlenfeld
Views92
Purpose: to evaluate the correlation between the laparoscopic aspects and the stromal histologic findings of peritoneal endometriosis in order to understand the evolutive theory of endometriosis. Methods: sixty-seven women were submitted to laparoscopy for pelvic pain, infertility, ovarian tumor and other pathologies. A peritoneal biopsy was taken from the typical (puckered black) and atypical endometriotic implants. The different aspects of endometriosis were classified as follows: red lesions (Group V), black lesions (Group N) and white lesions (Group B). The histological sections were examined according to a standardized protocol. The histologic parameters used were: depth of the lesion, presence of hemosiderin, vascularization of the stroma and fibrotic tissue in stroma. Results: regarding lesion depth, there were significant differences between the groups. Red lesions were located consistently on the surface of the peritoneum (100%) and black lesions were superficial in 55.6%, intermediate in 38.9% and deep in 5.5%. White lesions were superficial in 28%, intermediate in 68% and deep in 4%. The presence of hemosiderin showed equivalent results in the 3 groups. The large stromal vascularization was present in the red lesions (60%), which a statistically significant difference compared to the other groups. Fibrotic tissue was present in 70.6% of the white lesions (group B), a fact that was significantly different when compared to groups V and N. Conclusion: the parameters analyzed in this study confirmed the importance of the evolutive theory of endometriosis.

Key-words Endometriosis Hemosiderin Laparoscopy Pelvic pain
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Original Article06-18-2002

Role of Clinical History and Physical Examination in the Diagnosis of Urinary Incontinence
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(2):87-91

Views68

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 Article
Role of Clinical History and Physical Examination in the Diagnosis of Urinary Incontinence
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(2):87-91
DOI 10.1590/S0100-72032002000200003
Paulo Cezar Feldner Jr,
Leonardo Robson P.S. Bezerra,
Manoel João Bastista C. Girão,
Rodrigo Aquino de Castro,
Marair Gracio F. Sartori,
Edmund Chada Baracat,
Geraldo Rodrigues de Lima
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Purpose: to analyze the prevalence of urogynecological symptoms and their relationship with final urodynamic diagnosis, and to compare the clinical sign of stress urinary incontinence with urodynamic diagnosis. Methods: a total of 114 patients were included in a retrospective study from June 2000 to January 2001. All patients were evaluated through medical interview, physical examination and urodynamic study. They were classified according to clinical symptom, presence of clinical sign of urine loss and urodynamic study. The data analysis was performed using a test to determine sensitivity, specificity, and positive and negative predictive values. Results: the mean age was 51 years (19-80), 61 patients (53.5%) were in menacme and 53 (46.5%) in postmenopausal stage. Ten (18.8%) were using hormone replacement therapy and 25 (21.9%) had been submitted to surgery for incontinence. The isolated clinical symptom of urine loss was reported in 41 (36.0%) patients, the isolated urgency/urgency-incontinence in 13 (11.4%) and mixed symptoms in 60 (52.6%). In the urodynamic study, of all patients with symptom of isolated urine loss, 34 (83%) had stress urinary incontinence (SUI), no patient had detrusor instability (DI), 2 (4.9%) had mixed incontinence (MI) and 5 (12.1%) had a normal result. Of all patients with isolated urgency/urgency-incontinence, in the urodynamic study, none had SUI, 5 (38.5%) had ID, 1 (7.7%) had MI and 7 (53.8%) had a normal result. Of the patients with mixed symptoms, we identified, on the urodynamic evaluation, 25 (41.6%) who had SUI, 10 (16.7%) ID, 10 (16.7%) MI and 15 (25.0%) a normal result. The clinical sign of urine loss was identified in 50 (43.9%) patients. A total of 35 (70%) had SUI on urodynamic study, 6 (12%) had SUI and another diagnosis and 9 (18%) did not have SUI. Urine loss was absent in 64 (56.1%) women. Of those 23 (35.9%) had SUI on urodynamic study, 7 (11%) had SUI and another diagnosis and 34 (53.1%) did not have SUI. Conclusions: clinical history and physical examination are important in the management of urinary incontinence, although they should not be used as the only diagnostic method. Objective tests are available and should be used together with clinical data.

Key-words Clinical examination Urinary incontinence Urodynamic study
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Original Article06-18-2002

Sentinel Lymph Node Accuracy in Early Breast Cancer Treated with Neoadjuvant Chemotherapy
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(2):81-86

Views122

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 Article
Sentinel Lymph Node Accuracy in Early Breast Cancer Treated with Neoadjuvant Chemotherapy
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(2):81-86
DOI 10.1590/S0100-72032002000200002
José Roberto Morales Piato,
Alfredo Carlos Simões Dornellas de Barros,
Katia Maciel Pincerato,
Adriano Oliveira Vigário,
José Aristodemo Pinotti
Views122
Purpose: to evaluate the predictive capacity of the sentinel lymph node (SLN) in relation to the axillary lymph node status in patients with initial invasive breast carcinoma submitted or not to neoadjuvant chemotherapy. Method: a prospective study was performed in 112 patients divided into two groups. The first group comprised 70 patients who had not received previous chemotherapy (Group I) and the second consisted of 42 patients who were submitted to neoadjuvant chemotherapy in three cycles of AC (adriamycin + cyclophosphamide) (Group II). Regarding chemotherapy, we observed partial response >50% in 21 patients, being complete in three of them, and <50% in 19 patients; in two patients progression of the disease occurred. A peritumoral injection of 99mTc dextran was applied with the help of stereotaxy in 29 patients with nonpalpable tumors, 16 of Group I and 13 of Group II. The radioactive accumulation shown by scintigraphy guided the biopsy of the axillary SLN with the help of a probe. The anatomopathologic study of SLN was based initially on a single section. When the LSN was free, it was submitted to serial sections at 50 mum intervals, stained with HE. Results: SLN was identified in 108 patients. No identification has been obtained in four patients, all with nonpalpable lesions (3 patients of Group I and 1 of Group II). The method's accuracy in predicting the axillary lymph node status was 100% in patients who did not receive neoadjuvant chemotherapy and 93% in those to whom this kind of treatment was administered. This difference proved to be statistically significant. Conclusions: the present study allowed us to conclude that in all patients who did not receive previous chemotherapy treatment, the SLN study was effective in predicting the axillary lymph node status. The high rate of false-negative results in the group of patients submitted to neoadjuvant chemotherapy seems to invalidate the use of SLN study these patients.

Key-words Breast cancer Neoadjuvant chemotherapy Sentinel lymph node
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Editorial
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(2):79-79

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Abstract
Editorial
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(2):79-79
DOI 10.1590/S0100-72032002000200001
Views34
Editorial A Revista Brasileira de Ginecologia e Obstetrícia (RBGO), como já é do conhecimento de todos, é a única publicação na área de Ginecologia e Obstetrícia que está indexada mo SciELO (Scientific Electronic Library Online).[…]
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ISSUE

The Trial of Labor After one Cesarean Section

DECLARAÇÃO DE BARCELONA

A Grande Vitória

Microinvasive Carcinoma in the Cone Specimen in Women With Colposcopically Directed Biopsy Suggesting CIN 3

Contribuição ao Estudo do Laser de Vapor de Cobre no Tratamento da Endometriose Induzida Cirurgicamente em Coelhas

Avaliação do Potencial de Peroxidação Lipídica no Fluido Peritoneal de Mulheres Inférteis com Endometriose Pélvica

Prevalência das Neoplasias Intra-epiteliais Cervicais e Lesões Induzidas pelo HPV nas Mulheres Soropositivas/AIDS

Mayer-Rokitansky-Kuster-Hauser syndrome

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Hysterectomy rates per resident in final year of training in teaching hospitals: an ecologic study

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Prevalence of antiphospholipid syndrome among women with recurrent pregnancy loss: a cohort study

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An assessment of total antioxidant and oxidant parameters and their correlation with embryo quality in in-vitro fertilization patients

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Letrozole and clomiphene versus letrozole alone for ovulation induction in women with PCOS: a systematic review and meta-analysis

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Incidence of small-for-gestational-age newborns in pregnant women with COVID-19

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Efficacy of tranexamic acid application in gynecology and obstetrics procedures: a umbrella review of systematic reviews of randomized trials

Abstract

Objective:

Methods:

Results:

Conclusions:

Computerized Antepartum Cardiotocography Analysis in High Risk Pregnancies

Predictive Model using Risk Factors for Cesarean Section

Maternal Morbidity and Perinatal Morbidity and Mortality Associated with Ascendant Infection in Premature Rupture of Membranes

Maternal Serum Level of C-reactive Protein in Gestations Complicated by Preeclampsia

Correlation Between Laparoscopic Aspects and Histologic Findings in Peritoneal Endometriotic Lesions

Role of Clinical History and Physical Examination in the Diagnosis of Urinary Incontinence

Sentinel Lymph Node Accuracy in Early Breast Cancer Treated with Neoadjuvant Chemotherapy

Editorial

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