Articles - Revista Brasileira de Ginecologia e Obstetrícia

Técnicas e Equipamentos
A new catheter in the treatment of fetal obstructive uropathies
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):155-159
04-10-1998

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Summary
Técnicas e Equipamentos
A new catheter in the treatment of fetal obstructive uropathies
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):155-159
04-10-1998
DOI 10.1590/S0100-72031998000300006
Ana Paula B.M. Lopes,
Antônio Carlos V. Cabral,
Henrique Vitor Leite
Views52
Management of prenatally diagnosed uropathies is controversial, mainly because the prognosis for these fetuses is quite different. However pioneering studies have shown that prenatal drainage of obstructed urinary tract can improve the outcome of selected fetuses. The aim of this study is to describe the experience of the Service with the treatment of fetal obstrutive uropathy with the catheter developed by the Centro de Medicina Fetal do Hospital das Clínicas da UFMG. A total of 25 fetuses with obstructive uropathy received the catheter. Three fetuses required more than one insertion. Ten of 25 (40%) shunted fetuses survived with good postnatal renal and pulmonary function. Complications occurred in 12/25 (48%) cases including: 06/25 (24%) inadequate shunt drainage or migration; 01/25 (04%) urinary ascitis; 01/25 (04%) DPP, 01/25 (04%) premature rupture of membranes, 02/25 (08%) premature labor, 01/25 (04%) scarring and fibrosis of the renal parenchyma. Three of 25 (12%) fetuses died intra-utero and 12 (48%) died during the neonatal period. In conclusion, the drainage of the obstructed urinary tract with this catheter proved to be technically feasible and safe for both mother and fetus, with a survival rate of 40%.

Key-words Fetal anomalies Fetal therapy Obstructive uropathy
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Trabalhos Originais
Prevalence and correlates of hiv infection and syphilis in prostitutes attending a STD/AIDS reference center
- Isabel Cristina Pinheiro Pires,
- Angélica Espinosa Barbosa Miranda
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):151-154
04-10-1998

Views89

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 Originais
Prevalence and correlates of hiv infection and syphilis in prostitutes attending a STD/AIDS reference center
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):151-154
04-10-1998
DOI 10.1590/S0100-72031998000300005
Isabel Cristina Pinheiro Pires,
Angélica Espinosa Barbosa Miranda
Views89
A retrospective study examining medical records of female prostitutes attending the STD/AIDS Reference Center in Vitória, Brazil from January/93 to December/96 was conducted. During this period, 180 women received medical and psychological care in this clinic. Mean age was 25.9 year (SD=6.8). Out of 180, 140 agreed to be tested for HIV, of whom 12 (8.6%) had a positive result. Among 157 women who agreed to be tested for syphilis, 144 (91.7%) had a negative result, while 13 (8.3%) had a positive one. According to the educational degree, 6 (3.3%) women were illiterate, 114 (63.3%) attended elementary school, 37 (20.6%) attended secondary school, 7 (3.9%) went to college and 16 gave no information. One hundred and forty-one patients (78.3%) were single, 17 (9.4%) married, 10 (5,5%) divorced and 4 (2.2%) widows. The frequency of condom use was: always, 56 (31.3%), sometimes, 93 (52.0%), and 30 (16.8%) never used condoms. Other STDs were reported by 89 (49.4%) women and 9 (5.0%) reported intravenous (IV) drug use. There was a significant difference between the HIV positive and the negative group only regarding IV drug abuse (p=0.031) and syphilis infection (p=0.014). The present study showed prevalence rates of HIV infection among prostitutes in Vitória much higher than those found in the general population. There is a pressing need to improve medical assistance and educational campaigns especially designed to reach this population of women, and focusing the importance of regular condom use and the risks associated with IV drug abuse.

Key-words AIDS Drug addiction Primary care Prostitution STD Syphilis
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Trabalhos Originais
Obstetrical management of fetal death
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):145-149
04-10-1998

Views157

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Summary
Trabalhos Originais
Obstetrical management of fetal death
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):145-149
04-10-1998
DOI 10.1590/S0100-72031998000300004
Márcia M A de Aquino,
Ana Cláudia Guedes,
Maria Rita S Mesquita,
Mirie Hernandez,
José Guilherme Cecatti
Views157
Although 80 to 90% of all dead fetuses may be spontaneously eliminated after two to three weeks from death, labor induction has been the mostly used management. The purpose of the current study was to evaluate the results of labor induction for pregnancies with fetal death and gestation age above 20 weeks. It was a descriptive clinical study which was performed at the Hospital e Maternidade Leonor Mendes de Barros in São Paulo, Brazil. One hundred and twenty-two pregnancies with fetal death were evaluated regarding their social and demographic characteristics, causes of fetal death, previous pregnancies history and delivery (induction, route, complications). The statistical procedures used were estimation of mean and standard deviation and chi². The main causes of fetal death were hypertension and infections. The mostly used drug for labor induction was misoprostol (37.7%) followed by oxytocin (19.7%), while 27% of cases had spontaneous onset of labor. The mean time of induction was 3 hours. The majority of women had vaginal delivery and cesarean section was performed in 9.1% of them. It is concluded that labor induction for fetal death is safe and efficient, irrespective of the method used. Misoprostol when used in the vagina is specially useful for cases with an unripe cervix because of the modifying effect of the drug on the cervix.

Key-words Fetal death Labor Oxytocin Prostaglandin
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Trabalhos Originais
Intrauterine transfusion in fetuses affected by severe perinatal hemolytic disease: a descriptive study
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):137-144
04-10-1998

Views105

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Summary
Trabalhos Originais
Intrauterine transfusion in fetuses affected by severe perinatal hemolytic disease: a descriptive study
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):137-144
04-10-1998
DOI 10.1590/S0100-72031998000300003
Dorival Antônio Vitorello,
Luiz Miguel Mitri Parente,
Rodolfo João Ramos,
Luís Flávio de Andrade Gonçalves,
Cláudia Diniz Baumgarten,
Jorge Abi Saab Neto
Views105
Objective: to report 54 intrauterine intravascular transfusions (IITs), describing procedure related complications and associated perinatal morbidity and mortality. Methods: fetuses undergoing IITs at Clínica Materno-Fetal and Maternidade Carmela Dutra, Florianópolis, SC, between January 1992 and August 1997 were included in the study. Patients demographics, procedure and newborn related data were tabulated for analysis and presented in descriptive form, using percentage, mean, standard deviation, median, range and relative risk (RR) with 95% confidence interval as appropriate. Results: fifty IITs and four exchange transfusions were performed in twenty-one fetuses. There were four deaths (20%), three of which occurred (75%) in hydropic fetuses. Mean gestational age at the time of the first IIT was 29.1 weeks, the mean hemoglobin concentration was 7.1 mg/dl and the mean rise in hemoglobin level per procedure was 5.69 mg/dl. Procedure related mortality rate was 7.4%. Mean gestational age at birth was 33.9 weeks and mean birth weight was 2,437 grams. Sixty-five percent of the newborns received complementary exchange transfusions. Conclusion: the procedure related mortality rate was 7.4%, similar to the mortality rate reported in the world literature. The perinatal mortality rate (20%) was higher than that reported in other countries but lower than the perinatal mortality rate reported in a study conducted in Brazil, with a similar prevalence of hydropic fetuses.

Key-words Cordocentesis Fetal blood sampling Hemolytic disease Intrauterine transfusion Isoimmunization
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Trabalhos Originais
Index for the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):127-135
04-10-1998

Views77

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Summary
Trabalhos Originais
Index for the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):127-135
04-10-1998
DOI 10.1590/S0100-72031998000300002
Julio Elito Junior,
André Reichmann,
Mary N. Uchiyama,
Luiz Camano
Views77
A prospective study was performed with 42 patients with unruptured ectopic pregnancy, which intended to elaborate an index to orient the systemic treatment with the administration of a single intramuscular dose of methotrexate (50 mg/m²). Patients were monitored with beta-hCG titers on days 1, 4 and 7 after the methotrexate. When the titers of beta-hCG declined more than 15%, between days 4 and 7 after methotrexate, the patients were discharged and had an outpatient follow-up monitored with beta-hCG titers weekly until the titers were less than 5 mIU/ml, which represents success of the treatment. We prepared an index for the systemic treatment with methotrexate, with five parameters: (1) initial titers of beta-hCG; (2) aspects of the image at ultrasound (hematosalpinx, gestational sac, live embryo); (3) size of the mass; (4) free fluid in cul-de-sac; (5) collor doppler. Each parameter received a grade from 0 to 2. Grade 0 represented bad prognosis, favorable parameters received grade 2 and borderline parameters received grade one. The success rate with a single dose of methotrexate was 69.0% (29/42). The color doppler was performed in 20 of the 42 patients; in this group of 20 patients the success rate was 75.0% (15/20). In the 22 patients who were not submitted to the color doppler, the average grade of the score in the successful cases was 6.6, and in the unsuccessful it was 3.1. In the group who underwent the doppler (20 patients) the average was 7.9 in the successful cases and 4.2 in the cases that failed. In the present study the cut-off grade was 5, for most of the patients with grades above 5 had a successful treatment (15/16 – 93.75%), while grades equal or below 5 failed. The score will help to indicate the best cases for the medical treatment. We do not advise the treatment when the grade is equal or below 5. Therefore, we can predict a good evolution of the treatment when the grade is above five.

Key-words Chemotherapy Ectopic pregnancy Methotrexate
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Editorial
A coordenação necessária
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):125-125
04-10-1998

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Summary
Editorial
A coordenação necessária
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):125-125
04-10-1998
DOI 10.1590/S0100-72031998000300001
Views54
A Coordenação Necessária[…]
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Resumos de Teses
Estudo do teste de angiotensina ii em gestantes hipertensas crônicas na predição da pré-eclâmpsia superajuntada
- Marco Aurelio Knipell Galletta
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):542-542
04-09-1998

Views33

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
Resumos de Teses
Estudo do teste de angiotensina ii em gestantes hipertensas crônicas na predição da pré-eclâmpsia superajuntada
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):542-542
04-09-1998
DOI 10.1590/S0100-72031998000900011
Marco Aurelio Knipell Galletta
Views33
Estudo do Teste de Angiotensina II em Gestantes Hipertensas Crônicas na Predição da Pré-Eclâmpsia Superajuntada. […]
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Resumos de Teses
Índice proteinúria/creatininúria em gestantes com hipertensão arterial sistêmica
- José Geraldo Lopes Ramos
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):542-542
04-09-1998

Views53

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
Resumos de Teses
Índice proteinúria/creatininúria em gestantes com hipertensão arterial sistêmica
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):542-542
04-09-1998
DOI 10.1590/S0100-72031998000900012
José Geraldo Lopes Ramos
Views53
Índice Proteinúria/Creatininúria em Gestantes com Hipertensão Arterial Sistêmica […]
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Original Article
Screening and prevention of preterm birth: how is it done in clinical practice?
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo32
04-09-2024

Views485

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Summary
Original Article
Screening and prevention of preterm birth: how is it done in clinical practice?
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo32
04-09-2024
DOI 10.61622/rbgo/2024rbgo32
Roberta Bulsing dos Santos ,
Janete Vettorazzi ,
Marcos Wengrover Rosa ,
Ellen Machado Arlindo ,
Edimárlei Gonsales Valério
Views485
Abstract

Objective:

To ascertain how screening for preterm birth is performed among obstetricians working in public and private practice in a middle-income country.

Methods:

Cross-sectional study of 265 obstetrician-gynecologists employed at public and private facilities. An online questionnaire was administered, with items designed to collect data on prematurity screening and prevention practices.

Results:

The mean age of respondents was 44.5 years; 78.5% were female, and 97.7% had completed a medical residency program. Universal screening (i.e., by ultrasound measurement of cervical length) was carried out by only 11.3% of respondents in public practice; 43% request transvaginal ultrasound if the manual exam is abnormal, and 74.6% request it in pregnant women with risk factors for preterm birth. Conversely, 60.7% of respondents in private practice performed universal screening. This difference in screening practices between public and private practice was highly significant (p < 0.001). Nearly all respondents (90.6%) reported prescribing vaginal progesterone for short cervix.

Conclusion:

In the setting of this study, universal ultrasound screening to prevent preterm birth was used by just over half of doctors in private practice. In public facilities, screening was even less common. Use of vaginal progesterone in cervical shortening was highly prevalent. There is an unmet need for formal protocols for screening and prevention of preterm birth in middle-income settings.

Key-words attitudes, practice Cervical length measurement gynecologists health knowledge Infant, premature obstetricians Preterm birth Prevention Screening surveys and questionnaires
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Original Article
Transforming growth factor beta-1 (TGF-β1) expression in patients with adenomyosis
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo31
04-09-2024

Views460

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Summary
Original Article
Transforming growth factor beta-1 (TGF-β1) expression in patients with adenomyosis
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo31
04-09-2024
DOI 10.61622/rbgo/2024rbgo31
Andreia Jacobo ,
Renata Fogaça Borges ,
Carlos Augusto Bastos de Souza ,
Vanessa Krebs Genro ,
João Sabino Cunha-Filho
Views460
Abstract

Objective:

To compare Transforming growth factor beta-1 (TGF-β1) expression in patients with and without adenomyosis.

Methods:

A prospective design was performed including 49 patients submitted to hysterectomy. Immunohistochemistry was performed on anatomopathological samples staged in paraffin blocks from patients with and without adenomyosis. The sample contained 28 adenomyosis cases and 21 controls. Student’s t-test and multivariate logistic regression tests were used for statistical analysis. Associations were considered significant at p < 0.05.

Results:

We found no significant association between adenomyosis and: smoking (p = 0.75), miscarriage (p = 0.29), number of previous pregnancies (p = 0.85), curettage (p = 0.81), pelvic pain (p = 0.72) and myoma (p = 0.15). However, we did find a relationship between adenomyosis and abnormal uterine bleeding (AUB) (p = 0.02) and previous cesarean section (p = 0.02). The mean TGF-β1 intensity (mean ± SD) in the ectopic endometrium of women with adenomyosis showed no significant association (184.17 ± 9.4 vs.184.66 ± 16.08, p = 0.86) from the topic endometrium of women without adenomyosis.

Conclusion:

TGF-β1 expression was not increased in the ectopic endometrium of women with adenomyosis.

Key-words Adenomyosis Etiopathogenesis Immunohistochemistry Transforming growth factor β1
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Original Article
Prevalence and factors associated with anxiety, depression and burnout in gynecology and obstetrics residents during the COVID-19 pandemic
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo17
00-00-2024

Views457

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Summary
Original Article
Prevalence and factors associated with anxiety, depression and burnout in gynecology and obstetrics residents during the COVID-19 pandemic
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo17
00-00-2024
DOI 10.61622/rbgo/2024AO17
Maria Luiza de Castro Amaral ,
Isabela Michel da Silva ,
Alexandre Ferreira Bello ,
Franciele Cascaes da Silva ,
Gustavo Salata Romão ,
Alberto Trapani Júnior
Views457
Abstract

Objective:

To determine the prevalence of anxiety, depression and burnout in residents of Gynecology and Obstetrics during COVID-19 pandemic in Brazil and its associated factors.

Methods:

Cross-sectional study involving all regions of Brazil, through the application of a sociodemographic questionnaire, the Hospital Anxiety and Depression Scale (HAD) and the Maslach Burnout Inventory (MBI-HSS) instrument. Multivariate analysis was performed after adjusting the Poisson model.

Results:

Among the 719 participating medical residents, screening was positive for anxiety in 75.7% and for depression in 49.8% of cases. Burnout syndrome was evidenced in 41.3% of the physicians studied. Those with depression are more likely to have anxiety (OR 0.797; 95%CI 0.687 – 0.925) and burnout syndrome (OR 0.847 95%CI 0.74 – 0.97). Residents with anxiety (OR 0.805; 95%CI 0.699 – 0.928) and burnout (OR 0.841; 95%CI 0.734 – 0.963) are more likely to have depression.

Conclusion:

High prevalence of anxiety, depression and burnout were found in residents of Gynecology and Obstetrics in Brazil, in addition to important correlations between anxiety-depression and depression-burnout.

Key-words Anxiety Brazil Burnout, psychological COVID-19 Depression Gynecology internship and residency medical residency Mental health Obstetrics pandemics
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Original Article
Gender affirming hormone therapy and transgender women fertility: Histologic predictors of germ cell presence
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo33
04-09-2024

Views455

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Summary
Original Article
Gender affirming hormone therapy and transgender women fertility: Histologic predictors of germ cell presence
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo33
04-09-2024
DOI 10.61622/rbgo/2024rbgo33
Lina Rigodanzo Marins ,
Tiago Elias Rosito ,
Lucia Maria Kliemann ,
Edson Capp ,
Helena von Eye Corleta
Views455
Abstract

Objective:

Evaluate histological changes in testicular parameters after hormone treatment in transgender women.

Methods:

Cross-section study with patients who underwent gonadectomy at Hospital de Clínicas de Porto Alegre from 2011 to 2019. Hormone treatment type, route of administration, age at initiation and duration were recorded. Atrophy parameters were observed: testicular volume, tubular diameter, basal membrane length, presence of spermatogonia and spermatids (diploid and haploid spermatozoid precursors).

Results:

Eighty-six patients were included. Duration of hormone treatment is associated with testicular atrophy and spermatogenesis arrest. Other characteristics of hormone treatment such as age of initiation, route of administration and type of treatment were not associated with testicular histological changes. Testicular volume may predict spermatogenesis arrest. Basal membrane length and tubular diameter ratio is an interesting predictor of germ cell presence.

Conclusion:

Cross-sex hormone treatment affects testicular germ cell presence. Basal membrane length and tubular diameter ratio reduces inter variability of measurements and better exemplify how atrophic seminiferous tubules are. Fertility preservation should be addressed by healthcare providers in order to recognize gender affirming treatment impact on transgender health.

Key-words Fertility Fertility preservation Gonadal steroid hormones Hormone treatment Spermatogenesis Transgender persons Transgender women
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Original Article
Association of placental histopathological findings with COVID-19 and its predictive factors
- Zeena Helmi ,
- Hadeel Al-badri
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo3
00-00-2024

Views446

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Summary
Original Article
Association of placental histopathological findings with COVID-19 and its predictive factors
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo3
00-00-2024
DOI 10.61622/rbgo/2024AO03
Zeena Helmi ,
Hadeel Al-badri
Views446
Abstract

Objective:

The aims of the study are to describe the association of coronavirus disease (COVID-19) with the abnormal histopathological findings in human placenta and to highlight the potential predictors of these histopathological findings.

Methods:

A retrospective cohort study, held in two obstetric units from January 2021- 2022, 34 patients who were confirmed cases of COVID- 19 were followed up till the time of delivery as their placenta were sent for histopathology. Patients diagnosed with other viral infections, chorioamnionitis, or were known case of as pre-term or term pre labour rupture of membrans (PROM) were excluded as well as pre exisiting diabetes mellitus or pre-eclampsia. Data analysis were performed using STATA software version 16.

Result:

Specific histopatological findings (fetal vascular malperfusion, maternal vascular malperfusion, inflammatory pathology and thrombotic finding) were significantly high among 13 (38.2%) of the study group who got infected earlier in pregnancy (P<0.001). The period between the diagnosis of COVID-19 and the delivery significantly increases the odds of the presence of pathological findings by 2.75 times for each week the patients getting infected earlier.

Conclusion:

Association of abnormal placental histopathological findings with COVID-19 infection in pregnancy and the potential predictor for the occurrence of placental findings is the longer duration between the diagnosis of the infection and the delivery.

Key-words coronavirus infections COVID-19 Histopathology Placenta
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Original Article
Translation, cross-cultural adaptation to Brazilian Portuguese and measurement properties of the WaLIDD score
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo16
00-00-2024

Views433

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Summary
Original Article
Translation, cross-cultural adaptation to Brazilian Portuguese and measurement properties of the WaLIDD score
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo16
00-00-2024
DOI 10.61622/rbgo/2024AO16
Mariana Arias Avila ,
Guilherme Tavares de Arruda ,
Amanda Garcia de Godoy ,
Patricia Driusso
Views433
Abstract

Objective:

Dysmenorrhea is the pain related to menstruation; to screen for the symptoms, a working ability, location, intensity of days of pain, and dysmenorrhea (WaLIDD) score was created. The purpose of this work was to culturally adapt and assess the measurement properties of the WaLIDD score for dysmenorrhea in Brazilian women.

Methods:

In this cross-sectional online study, we evaluated women with and without dysmenorrhea. Criterion validity and construct validity were assessed, respectively, by the Receiver Operator Characteristic (ROC) curve and correlations with the bodily pain and social functioning domains of medical outcomes study 36-item short-form health survey (SF-36), self-report of absenteeism and Stanford Presenteeism Scale for presenteeism. Test-retest reliability and measurement errors were assessed, respectively, by intraclass correlation coefficient (ICC) and Bland and Altman Graph.

Results:

430 women completed the test, 238 (55.4%) women had dysmenorrhea, and 199 (46.3%) answered the questionnaire twice for the retest. The cutoff points ≥4, ≥5, and ≥5 could discriminate between women with and without dysmenorrhea, absenteeism, and presenteeism related to dysmenorrhea, respectively. Correlations between SF-36 – pain and social functioning domains and WaLIDD score were weak to strong and negative. For WaLIDD total Score, ICC was 0.95 and the limits of agreement were −1.54 and 1.62.

Conclusion:

WaLIDD score is a short, valid and reliable instrument to screen and predict dysmenorrhea and could predict absenteeism and presenteeism related to dysmenorrhea in Brazilian women.

Key-words Dysmenorrhea Pain surveys and questionnaires Women's health
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Original Article
Postpartum hemorrhage in electronic health records: risk factors at admission and in-hospital occurrence
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo14
00-00-2024

Views429

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Summary
Original Article
Postpartum hemorrhage in electronic health records: risk factors at admission and in-hospital occurrence
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo14
00-00-2024
DOI 10.61622/rbgo/2024AO14
Raíssa Isabelle Leão Martins ,
Jussara de Souza Mayrink Novais ,
Zilma Silveira Nogueira Reis
Views429
Abstract

Objective:

Postpartum hemorrhage (PPH) is the leading cause of maternal death globally. Therefore, prevention strategies have been created. The study aimed to evaluate the occurrence of PPH and its risk factors after implementing a risk stratification at admission in a teaching hospital.

Methods:

A retrospective cohort involving a database of SISMATER® electronic medical record. Classification in low, medium, or high risk for PPH was performed through data filled out by the obstetrician-assistant. PPH frequency was calculated, compared among these groups and associated with the risk factors.

Results:

The prevalence of PPH was 6.8%, 131 among 1,936 women. Sixty-eight (51.9%) of them occurred in the high-risk group, 30 (22.9%) in the medium-risk and 33 (25.2%) in the low-risk group. The adjusted-odds ratio (OR) for PPH were analyzed using a confidence interval (95% CI) and was significantly higher in who presented multiple pregnancy (OR 2.88, 95% CI 1.28 to 6.49), active bleeding on admission (OR 6.12, 95% CI 1.20 to 4.65), non-cephalic presentation (OR 2.36, 95% CI 1.20 to 4.65), retained placenta (OR 9.39, 95% CI 2.90 to 30.46) and placental abruption (OR 6.95, 95% CI 2.06 to 23.48). Vaginal delivery figured out as a protective factor (OR 0.58, 95% CI 0.34 to 0.98).

Conclusion:

Prediction of PPH is still a challenge since its unpredictable factor arrangements. The fact that the analysis did not demonstrate a relationship between risk category and frequency of PPH could be attributable to the efficacy of the strategy: Women classified as “high-risk” received adequate medical care, consequently.

Key-words Electronic health records Maternal mortality Postpartum hemorrhage Puerperal disorders Risk factors
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Original Article
Vascular contraction of umbilical arteries of pregnant women with preeclampsia
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo2
00-00-2024

Views413

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Summary
Original Article
Vascular contraction of umbilical arteries of pregnant women with preeclampsia
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo2
00-00-2024
DOI 10.61622/rbgo/2024AO02
Gabriela Morelli Zampieri ,
Priscila Rezeck Nunes ,
Joelcio Francisco Abbade ,
Carlos Alan Dias Junior ,
Valeria Cristina Sandrim
Views413
Abstract

Objective:

Potassium channels have an important role in the vascular adaptation during pregnancy and a reduction in the expression of adenosine triphosphate-sensitive potassium channels (Katp) has been linked to preeclampsia. Activation of Katp induces vasodilation; however, no previous study has been conducted to evaluate the effects of the inhibition of these channels in the contractility of preeclamptic arteries. Glibenclamide is an oral antihyperglycemic agent that inhibits Katp and has been widely used in vascular studies.

Methods:

To investigate the effects of the inhibition of K_atp, umbilical arteries of preeclamptic women and women with healthy pregnancies were assessed by vascular contractility experiments, in the presence or absence of glibenclamide. The umbilical arteries were challenged with cumulative concentrations of potassium chloride (KCl) and serotonin.

Results:

There were no differences between the groups concerning the maternal age and gestational age of the patients. The percentage of smokers, caucasians and primiparae per group was also similar. On the other hand, blood pressure parameters were elevated in the preeclamptic group. In addition, the preeclamptic group presented a significantly higher body mass index. The newborns of both groups presented similar APGAR scores and weights.

Conclusion:

In the presence of glibenclamide, there was an increase in the KCl-induced contractions only in vessels from the PE group, showing a possible involvement of these channels in the disorder.

Key-words Glibenclamide Preeclampsia Umbilical arteries Vascular contractility
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Review Article
Efficacy of Hormonal and Nonhormonal Approaches to Vaginal Atrophy and Sexual Dysfunctions in Postmenopausal Women: A Systematic Review
- Ayane Cristine Alves Sarmento ,
- Ana Paula Ferreira Costa ,
- Juliana Lírio ,
- José Eleutério Jr ,
- Pedro Vieira Baptista ,
- Ana Katherine Gonçalves
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(10):986-994
01-23-2022

Views299

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Summary
Review Article
Efficacy of Hormonal and Nonhormonal Approaches to Vaginal Atrophy and Sexual Dysfunctions in Postmenopausal Women: A Systematic Review
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(10):986-994
01-23-2022
DOI 10.1055/s-0042-1756148
Ayane Cristine Alves Sarmento ,
Ana Paula Ferreira Costa ,
Juliana Lírio ,
José Eleutério Jr ,
Pedro Vieira Baptista ,
Ana Katherine Gonçalves
Views299
Abstract

Objective

To evaluate the efficacy of the hormonal and nonhormonal approaches to symptoms of sexual dysfunction and vaginal atrophy in postmenopausal women.

Data Sources

We conducted a search on the PubMed, Embase, Scopus, Web of Science, SciELO, the Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, as well as on clinical trial databases. We analyzed studies published between 1996 and May 30, 2020. No language restrictions were applied.

Selection of Studies

We selected randomized clinical trials that evaluated the treatment of sexual dysfunction in postmenopausal women.

Data Collection

Three authors (ACAS, APFC, and JL) reviewed each article based on its title and abstract. Relevant data were subsequently taken from the full-text article. Any discrepancies during the review were resolved by consensus between all the listed authors.

Data Synthesis

A total of 55 studies were included in the systematic review. The approaches tested to treat sexual dysfunction were as follows: lubricants and moisturizers (18 studies); phytoestrogens (14 studies); dehydroepiandrosterone (DHEA; 8 studies); ospemifene (5 studies); vaginal testosterone (4 studies); pelvic floor muscle exercises (2 studies); oxytocin (2 studies); vaginal CO₂ laser (2 studies); lidocaine (1 study); and vitamin E vaginal suppository (1 study).

Conclusion

We identified literature that lacks coherence in terms of the proposed treatments and selected outcome measures. Despite the great diversity in treatment modalities and outcome measures, the present systematic review can shed light on potential targets for the treatment, which is deemed necessary for sexual dysfunction, assuming that most randomized trials were evaluated with a low risk of bias according to the Cochrane Collaboration risk of bias tool. The present review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018100488).

Key-words Dyspareunia Estrogens Menopause orgasm Therapeutics
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Review Article
Placental Findings in Preterm and Term Preeclampsia: An Integrative Review of the Literature
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(7):560-569
10-18-2021

Views212

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Summary
Review Article
Placental Findings in Preterm and Term Preeclampsia: An Integrative Review of the Literature
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(7):560-569
10-18-2021
DOI 10.1055/s-0041-1730292
Luciana Pietro ,
José Paulo de Siqueira Guida ,
Guilherme de Moraes Nobrega ,
Arthur Antolini-Tavares ,
Maria Laura Costa
Views212
Abstract

Introduction

Preeclampsia (PE) is a pregnancy complication associated with increased maternal and perinatal morbidity and mortality. The disease presents with recent onset hypertension (after 20 weeks of gestation) and proteinuria, and can progress to multiple organ dysfunction, with worse outcomes among early onset preeclampsia (EOP) cases (<34 weeks). The placenta is considered the root cause of PE; it represents the interface between the mother and the fetus, and acts as a macromembrane between the two circulations, due to its villous and vascular structures. Therefore, in pathological conditions, macroscopic and microscopic evaluation can provide clinically useful information that can confirm diagnosis and enlighten about outcomes and future therapeutic benefit.

Objective

To perform an integrative review of the literature on pathological placental findings associated to preeclampsia (comparing EOP and late onset preeclampsia [LOP]) and its impacts on clinical manifestations.

Results:

Cases of EOP presented worse maternal and perinatal outcomes, and pathophysiological and anatomopathological findings were different between EOP and LOP placentas, with less placental perfusion, greater placental pathological changes with less villous volume (villous hypoplasia), greater amount of trophoblastic debris, syncytial nodules, microcalcification, villous infarcts, decidual arteriolopathy in EOP placentas when compared with LOP placentas. Clinically, the use of low doses of aspirin has been shown to be effective in preventing PE, as well asmagnesium sulfate in preventing seizures in cases of severe features.

Conclusion

The anatomopathological characteristics between EOP and LOP are significantly different, with large morphological changes in cases of EOP, such as

Key-words anatomopathological characteristics maternal mortality and morbidity Placenta preeclampsia early onset preeclampsia late onset
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Review Article
Management Strategies for Sexuality Complaints after Gynecologic Cancer: A Systematic Review
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(10):962-971
09-29-2022

Views148

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Summary
Review Article
Management Strategies for Sexuality Complaints after Gynecologic Cancer: A Systematic Review
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(10):962-971
09-29-2022
DOI 10.1055/s-0042-1756312
Luciane Machado Pizetta ,
Augusto da Cunha Reis ,
Mirian Picinini Méxas ,
Vanessa de Almeida Guimarães ,
Carmen Lucia de Paula
Views148
Abstract

Objective

To explore the main sexuality complaints of gynecologic cancer survivors after treatment and to identify the care strategies provided.

Data Source

Searches were conducted in six electronic databases: Scopus, Web of Science, LILACS, MEDLINE, PsychINFO, and EMBASE.

Study Selection

Articles published between 2010 and 2020 were selected and the following descriptors were used in the English language: female genital neoplasms and gynaecological cancer. The methodological quality of the studies used the Mixed Methods Appraisal Tool (MMAT).

Data Collection

The primary data extracted were: names of the authors, year of publication, country of origin, objective and type of study, data collection instrument, sample size and age range, types of cancer, and symptoms affected with the strategies adopted.

Data Summary

A total of 34 out of 2,536 screened articles were included. The main strategies found for patient care were patient-clinician communication, practices for sexuality care, individualized care plan, multiprofessional team support, and development of rehabilitation programs. For sexuality care, the most common practices are pelvic physiotherapy sessions and the use of vaginal gels and moisturizers.

Conclusion

The main complaints identified in the scientific literature were low libido and lack of interest in sexual activity, vaginal dryness, pain during sexual intercourse, and stenosis. Different care strategies may be adopted, such as follow-up with a multidisciplinary health team and sexual health rehabilitation programs, which could minimize these symptoms and ensure the quality of life of patients.

Key-words gynecological cancer Sexuality supportive care needs Survivors
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Review Article
Non-pharmacological Interventions for Improving Sleep Quality During Pregnancy: A Systematic Review and Meta-Analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(8):776-784
05-23-2022

Views215

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Summary
Review Article
Non-pharmacological Interventions for Improving Sleep Quality During Pregnancy: A Systematic Review and Meta-Analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(8):776-784
05-23-2022
DOI 10.1055/s-0042-1746200
Daiane Sofia Morais Paulino ,
Carolina Bicudo Borrelli ,
Débora Bicudo Faria-Schützer ,
Luiz Gustavo Oliveira Brito ,
Fernanda Garanhani Surita
Views215
Abstract

Objective

To investigate the effect of non-pharmacological interventions to improve sleep quality during pregnancy.

Data sources

A search was made in the NCBI/PubMed, ClinicalTrials.gov, Embase, BVS, and Web of Science databases. There were no limitations regarding language, sample size, and type of non-pharmacological intervention. We have included prospective clinical trials between July 2014 and July 2019.

Selection of studies

This study was registered in the Prospective International Registration of Systematic Reviews (PROSPERO) database was performed. Publication bias was also assessed with funnel plots. the primary outcome was the total score in the Pittsburgh Sleep Quality Index (PSQI) before and after intervention. Risk of bias and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria were used for assessing methodological quality. From the 28 retrieved studies, we have selected 8 for qualitative analysis and 6 for meta-analysis.

Data collection

Two independent reviewers performed the study selection. In the case of disagreement, a third senior reviewer was consulted. The study was initially assessed based on the title, followed by abstract. Lastly, the full text was assessed to be included.

Data Synthesis

A significant improvement on the sleep quality (PSQI score) was observed when all interventions were grouped (MD = -3.03, 95%CI -4.15 to -1.92, n= 623, i²= 84%, p< 0.001). Analysis by subgroup (music listening: MD = -1.96, 95% CI -3.27 to -0.65, n= 207, i²= 67%, p= 0.003 and other interventions: MD = -3.66, 95% CI -4.93 to -2.40, n= 416, i2 = 80%, p< 0.001) showed an improvement, with high heterogeneity. Risk of bias has shown performance and detection bias for almost studies, and GRADE evidence was very low for all analyzed variables.

Conclusion

Non-pharmacological interventions—listening to music, physical exercise, relaxation exercises, lettuce seed, sleep hygiene, and acupressure—are effective for improving sleep quality during pregnancy.

Key-words Meta-analysis non-pharmacological interventions Pregnant women sleep quality systematic review
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Case Report
Uterine Rescue in High-Risk Gestational Trophoblastic Neoplasia Treated with EMA-CO by Uterine Arteries Embolization due to Arteriovenous Malformations
- Arlley Cleverson Belo da Silva ,
- Jurandir Piassi Passos ,
- Roney Cesar Signorini Filho ,
- Antonio Braga ,
- Rosiane Mattar ,
- Sue Yazaki Sun
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(4):323-328
06-18-2021

Views175

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Summary
Case Report
Uterine Rescue in High-Risk Gestational Trophoblastic Neoplasia Treated with EMA-CO by Uterine Arteries Embolization due to Arteriovenous Malformations
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(4):323-328
06-18-2021
DOI 10.1055/s-0041-1725054
Arlley Cleverson Belo da Silva ,
Jurandir Piassi Passos ,
Roney Cesar Signorini Filho ,
Antonio Braga ,
Rosiane Mattar ,
Sue Yazaki Sun
Views175
Abstract

Complete hydatidiform mole (CHM) is a rare type of pregnancy, in which 15 to 20% of the cases may develop into gestational trophoblastic neoplasia (GTN). The diagnostic of GTN must be done as early as possible through weekly surveillance of serum hCG after uterine evacuation.We report the case of 23-year-old primigravida, with CHM but without surveillance of hCG after uterine evacuation. Two months later, the patient presented to the emergency with vaginal bleeding and was referred to the Centro de Doenças Trofoblásticas do Hospital São Paulo. She was diagnosed with high risk GTN stage/score III:7 as per The International Federation of Gynecology and Obstetrics/World Health Organization (FIGO/WHO). The sonographic examination revealed enlarged uterus with a heterogeneous mass constituted of multiple large vessels invading and causing disarrangement of the myometrium. The patient evolved with progressive worsening of vaginal bleeding after chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) regimen. She underwent blood transfusion and embolization of uterine arteries due to severe vaginal hemorrhage episodes, with complete control of bleeding. The hCG reached a negative value after the third cycle, and there was a complete regression of the anomalous vascularization of the uterus as well as full recovery of the uterine anatomy. The treatment in a reference center was essential for the appropriate management, especially regarding the uterine arteries embolization trough percutaneous femoral

Key-words EMA-CO protocol Gestational trophoblastic disease Gestational trophoblastic neoplasia High risk pregnancy Uterine artery embolization
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FEBRASGO POSITION STATEMENT
Abnormal uterine bleeding and chronic iron deficiency: Number 11 – December 2022
- Venina Viana de Barros ,
- Eliane Azeka Hase ,
- Cristiano Caetano Salazar ,
- Ana Maria Kondo Igai ,
- Fernanda Andrade Orsi ,
- Paulo Francisco Ramos Margarido
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(12):1161-1168
03-24-2022

Views204

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Summary
FEBRASGO POSITION STATEMENT
Abnormal uterine bleeding and chronic iron deficiency: Number 11 – December 2022
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(12):1161-1168
03-24-2022
DOI 10.1055/s-0042-1760235
Venina Viana de Barros ,
Eliane Azeka Hase ,
Cristiano Caetano Salazar ,
Ana Maria Kondo Igai ,
Fernanda Andrade Orsi ,
Paulo Francisco Ramos Margarido
Views204
Key points[…]
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Original Article
Increment of Maternal Mortality Among Admissions for Childbirth in Low-risk Pregnant Women in Brazil: Effect of COVID-19 Pandemic?
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(8):740-745
07-07-2022

Views143

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Summary
Original Article
Increment of Maternal Mortality Among Admissions for Childbirth in Low-risk Pregnant Women in Brazil: Effect of COVID-19 Pandemic?
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(8):740-745
07-07-2022
DOI 10.1055/s-0042-1751059
Bruna Depieri Michels ,
Daniela Ferreira D’Agostini Marin ,
Betine Pinto Moehlecke Iser
Views143
Abstract

Objective

To assess the possible impact of the COVID-19 pandemic on maternal mortality among admissions for childbirth in 2020 in relation of the last 10 years.

Methods

An ecological study with pregnant women who underwent hospital births at the Brazilian unified public health service (SUS, in the Portuguese acronym) in Brazil from 2010 to 2020. The mortality among admissions for childbirth was obtained based on the number of admissions for childbirth with reported death as outcome divided by the total number of admissions. The underlying gestational risk and route of delivery were considered based on the national surveillance system. The average mortality for the period between 2010 and 2019 (baseline) was compared with the rate of deaths in 2020 (1^st pandemic year); the rate ratio was interpreted as the risk of death in 2020 in relation to the average of the previous period (RR), with 95% confidence intervals (CIs).

Results

In 2020, the 1^st year of the COVID-19 pandemic, 1,821,775 pregnant women were hospitalized for childbirth and 651 deaths were reported, which represents 8.7% of the total hospitalizations and 11.3% of maternal deaths between 2010 and 2020. There was an increase in maternal mortality after births in 2020 compared with the average for the period between 2010 and 2019, specially in low-risk pregnancies, both in vaginal (RR = 1.60; 95%CI:1.39–1.85) and cesarean births (RR = 1.18; 95%CI:1.04–1.34).

Conclusion

Maternal mortality among admissions for childbirth according to SUS data increased in 2020 compared with the average between 2010 and 2019, with an increment of 40% in low-risk pregnancies. The increase was of 18% after cesarean section and of 60% after vaginal delivery.

Key-words COVID-19 health impact assessment maternal Mortality Postpartum period
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Review Article
Clinical Features and Maternal-fetal Results of Pregnant Women in COVID-19 Times
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(5):384-394
07-30-2021

Views237

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Summary
Review Article
Clinical Features and Maternal-fetal Results of Pregnant Women in COVID-19 Times
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(5):384-394
07-30-2021
DOI 10.1055/s-0041-1729145
Ana Paula Nogueira Godoi ,
Gilcelia Correia Santos Bernardes ,
Leilismara Sousa Nogueira ,
Patrícia Nessralla Alpoim ,
Melina de Barros Pinheiro
Views237
Abstract

Objective

Coronavirus disease 2019 (COVID-19) is a disease caused by a newly discovered coronavirus, severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), which usually leads to non-specific respiratory symptoms. Although pregnant women are considered at risk for respiratory infections by other viruses, such as SARS and Middle East respiratory syndrome (MERS), little is known about their vulnerability to SARS-CoV-2. Therefore, this study aims to identify and present the main studies on the topic, including the postpartum period.

Methods

In this narrative review, articles were searched in various databases, organizations, and health entities using keywords compatible with medical subject headings (MeSH), such as: COVID-19, pregnancy, vertical transmission, coronavirus 2019, and SARS-CoV-2.

Results

The review of the scientific literature on the subject revealed that pregnant women with COVID-19 did not present clinical manifestations significantly different from those of non-pregnant women; however, there are contraindicated therapies. Regarding fetuses, studies were identified that reported that infection by SARS-CoV-2 in pregnant women can cause fetal distress, breathing difficulties and premature birth, but there is no substantial evidence of vertical transmission.

Conclusion

Due to the lack of adequate information and the limitations of the analyzed studies, it is necessary to provide detailed clinical data on pregnant women infected with SARS-CoV-2 and on the maternal-fetal repercussions caused by this infection. Thus, this review may contribute to expand the knowledge of professionals working in the area as well as to guide more advanced studies on the risk related to pregnant women and their newborns. Meanwhile, monitoring of confirmed or suspected pregnant women with COVID-19 is essential, including in the postpartum period.

Key-words COVID-19 High risk pregnancy Pregnancy Pregnancy complications SARS-CoV-2
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ISSUE

A new catheter in the treatment of fetal obstructive uropathies

Prevalence and correlates of hiv infection and syphilis in prostitutes attending a STD/AIDS reference center

Obstetrical management of fetal death

Intrauterine transfusion in fetuses affected by severe perinatal hemolytic disease: a descriptive study

Index for the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate

A coordenação necessária

Estudo do teste de angiotensina ii em gestantes hipertensas crônicas na predição da pré-eclâmpsia superajuntada

Índice proteinúria/creatininúria em gestantes com hipertensão arterial sistêmica

Screening and prevention of preterm birth: how is it done in clinical practice?

Abstract

Objective:

Methods:

Results:

Conclusion:

Transforming growth factor beta-1 (TGF-β1) expression in patients with adenomyosis

Abstract

Objective:

Methods:

Results:

Conclusion:

Prevalence and factors associated with anxiety, depression and burnout in gynecology and obstetrics residents during the COVID-19 pandemic

Abstract

Objective:

Methods:

Results:

Conclusion:

Gender affirming hormone therapy and transgender women fertility: Histologic predictors of germ cell presence

Abstract

Objective:

Methods:

Results:

Conclusion:

Association of placental histopathological findings with COVID-19 and its predictive factors

Abstract

Objective:

Methods:

Result:

Conclusion:

Translation, cross-cultural adaptation to Brazilian Portuguese and measurement properties of the WaLIDD score

Abstract

Objective:

Methods:

Results:

Conclusion:

Postpartum hemorrhage in electronic health records: risk factors at admission and in-hospital occurrence

Abstract

Objective:

Methods:

Results:

Conclusion:

Vascular contraction of umbilical arteries of pregnant women with preeclampsia

Abstract

Objective:

Methods:

Results:

Conclusion:

Efficacy of Hormonal and Nonhormonal Approaches to Vaginal Atrophy and Sexual Dysfunctions in Postmenopausal Women: A Systematic Review

Abstract

Objective

Data Sources

Selection of Studies

Data Collection

Data Synthesis

Conclusion

Placental Findings in Preterm and Term Preeclampsia: An Integrative Review of the Literature

Abstract

Introduction

Objective

Results:

Conclusion

Management Strategies for Sexuality Complaints after Gynecologic Cancer: A Systematic Review

Abstract

Objective

Data Source

Study Selection

Data Collection

Data Summary

Conclusion

Non-pharmacological Interventions for Improving Sleep Quality During Pregnancy: A Systematic Review and Meta-Analysis

Abstract