Articles - Revista Brasileira de Ginecologia e Obstetrícia

Original Article04-10-1998

Intrauterine transfusion in fetuses affected by severe perinatal hemolytic disease: a descriptive study
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):137-144

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Abstract
Original Article
Intrauterine transfusion in fetuses affected by severe perinatal hemolytic disease: a descriptive study
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):137-144
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
Views127
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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Original Article04-10-1998

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

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Abstract
Original Article
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
DOI 10.1590/S0100-72031998000300002
Julio Elito Junior,
André Reichmann,
Mary N. Uchiyama,
Luiz Camano
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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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04-10-1998

A coordenação necessária
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):125-125

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Abstract
A coordenação necessária
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):125-125
DOI 10.1590/S0100-72031998000300001
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A Coordenação Necessária[…]
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04-09-1998

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

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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
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
DOI 10.1590/S0100-72031998000900011
Marco Aurelio Knipell Galletta
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Estudo do Teste de Angiotensina II em Gestantes Hipertensas Crônicas na Predição da Pré-Eclâmpsia Superajuntada. […]
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04-09-1998

Índice proteinúria/creatininúria em gestantes com hipertensão arterial sistêmica
- José Geraldo Lopes Ramos
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):542-542

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Abstract
Índice proteinúria/creatininúria em gestantes com hipertensão arterial sistêmica
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):542-542
DOI 10.1590/S0100-72031998000900012
José Geraldo Lopes Ramos
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Índice Proteinúria/Creatininúria em Gestantes com Hipertensão Arterial Sistêmica […]
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04-09-1998

Valor da histerossonografia na avaliação da cavidade endometrial na mulher com sangramento uterino anormal
- Luiz Guilherme Trevisan de Albuquerque
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):541-542

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Abstract
Valor da histerossonografia na avaliação da cavidade endometrial na mulher com sangramento uterino anormal
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):541-542
DOI 10.1590/S0100-72031998000900010
Luiz Guilherme Trevisan de Albuquerque
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Valor da Histerossonografia na Avaliação da Cavidade Endometrial na Mulher com Sangramento Uterino Anormal […]
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04-09-1998

Freqüência de mutação no códon 12 do gene K-ras no carcinoma ductal invasivo de mama, através da técnica da reação em cadeia da polimerase
- Sônia Maria Rolim Rosa Lima
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):541-541

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Abstract
Freqüência de mutação no códon 12 do gene K-ras no carcinoma ductal invasivo de mama, através da técnica da reação em cadeia da polimerase
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):541-541
DOI 10.1590/S0100-72031998000900009
Sônia Maria Rolim Rosa Lima
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Freqüência de Mutação no Códon 12 do Gene K-ras no Carcinoma Ductal Invasivo de Mama, Através da Técnica da Reação em Cadeia da Polimerase[…]
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Original Article04-09-1998

Vaginal hysterectomy: is the laparoscope necessary?
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):537-540

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Abstract
Original Article
Vaginal hysterectomy: is the laparoscope necessary?
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):537-540
DOI 10.1590/S0100-72031998000900008
Octacílio Figueiredo Netto,
Octacílio Figueiredo,
Eduardo Garcia Figueiredo,
Priscila Garcia Figueiredo
Views98
Purpose: the laparoscope can be used to convert an abdominal into a vaginal hysterectomy when there are contraindications for the vaginal approach, and not as a substitute for simple vaginal hysterectomy. The purpose of the present study is to discuss the role of laparoscopy in vaginal hysterectomy. Methods: between February 1995 and September 1998, 400 patients were considered candidates for vaginal hysterectomy.Exclusion criteria included uterine prolapse, adnexal tumor and uterine immobility. The Heaney technique was used, and different morcellation procedures were employed for the removal of enlarged uteri. Results: the mean age and parity was 46.9 years and 3.2 deliveries, respectively. Twenty-nine patients (7.2%) were nulliparous, and 104 (26.0%) had never delivered vaginally. Three hundred and three patients (75.7%) had a history of previous pelvic surgery, the most common being cesarean section (48.7%). The most frequent indication was leiomyoma (61.2%), and the mean uterine volume was 239.9 cm³ (30-1228 cm³). Vaginal hysterectomy was successfully performed in 396 patients (99.0%), and 73 surgeries (18.2%) were done by residents. The mean operative time was 45 min. Diagnostic/operative laparoscopy was performed in 16 patients (4.0%). Intraoperative complications included 6 cystotomies (1.5%) and one rectal laceration (0.2%). There were four conversions (1.0%) to the abdominal route. Postoperative complications occurred in 24 patients (6.0%). Two hundred and eighty-one patients (70.2%) were discharged 24 h after surgery. Conclusions: the laparoscope does not seem to be necessary in cases were the uterus is mobile and there is no adnexal tumor. The main role of the laparoscope may be to increase the awareness of gynecologists to the possibility of a simple vaginal hysterectomy in the majority of cases.

Key-words Hysterectomy Laparoscopy Surgery Vaginal surgery
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Original Article03-01-2018

The Burden of Indirect Causes of Maternal Morbidity and Mortality in the Processof Obstetric Transition: A Cross-Sectional Multicenter Study
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):106-114

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Abstract
Original Article
The Burden of Indirect Causes of Maternal Morbidity and Mortality in the Processof Obstetric Transition: A Cross-Sectional Multicenter Study
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(3):106-114
DOI 10.1055/s-0038-1623511
Jessica Fernandes Cirelli,
Fernanda Garanhani Surita,
Maria Laura Costa,
Mary Angela Parpinelli,
Samira Maerrawi Haddad,
José Guilherme Cecatti
Views214
Abstract

Objective

The aim of this study is to evaluate the burden of indirect causes of maternal morbidity/mortality in Brazil.

Methods

Secondary analysis of a multicenter cross-sectional study conducted in 27 referral obstetric units within the Brazilian Network for Surveillance of Severe Maternal Morbidity.

Results

A total of 82,388 women were surveilled: 9,555 women with severe maternal morbidity were included, and 942 (9.9%) of them had indirect causes of morbidity/ mortality. There was an increased risk of higher severity among the indirect causes group, which presented 7.56 times increased risk of maternal death (prevalence ratio [PR]: 7.56; 95% confidence interval [95%CI]: 4.99-11.45). The main indirect causes of maternal death were H1N1 influenza, sepsis, cancer and cardiovascular disease. Non-public antenatal care (PR: 2.52; 95%CI: 1.70-3.74), diabetes (PR: 1.90; 95%CI: 1.24-2.90), neoplasia (PR: 1.98; 95%CI: 1.25-3.14), kidney diseases (PR: 1.99; 95%CI: 1.14-3.49), sickle cell anemia (PR: 2.50; 95%CI: 1.16-5.41) and drug addiction (PR: 1.98; 95%CI: 1.03-3.80) were independentlyassociatedwithworseresultsintheindirectcausesgroup.Someprocedures for the management of severity were more common for the indirect causes group.

Conclusion

Indirect causes were present in less than 10% of the overall cases, but they represented over 40% of maternal deaths in the current study. Indirect causes of maternal morbidity/mortality were also responsible for an increased risk of higher severity, and they were associated with worse maternal and perinatal outcomes. In middle-income countries there is a mix of indirect causes of maternal morbidity/ mortality that points to some advances in the scale of obstetric transition, but also reveals the fragility of health systems.

Key-words indirect causes Maternal death maternal near miss Reproductive health
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Case Report06-19-2019

Spontaneous Heterotopic Triplet Pregnancy with a Two Viable Intrauterine Embryos and an Ectopic One with Right Tubal Rupture
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(4):268-272

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Abstract
Case Report
Spontaneous Heterotopic Triplet Pregnancy with a Two Viable Intrauterine Embryos and an Ectopic One with Right Tubal Rupture
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(4):268-272
DOI 10.1055/s-0039-1683910
Adriano Carvalho Guimarães ,
Luciano Dias de Oliveira Reis,
Fabio Chaves Leite,
Cassiana Franco Dias dos Reis,
Alex Paula Costa,
Walter Junior Boim de Araujo
Views213
Abstract

Heterotopic pregnancy (HP) is defined as the simultaneous development of an intra- and an extra uterine gestation. The occurrence of a spontaneous triplet HP is an exceptionally rare medical condition. We report the case of a young woman with spontaneous heterotopic triplets at 8weeks of gestation, with amisdiagnosis of topic twins and acute appendicitis. The ectopic tubal pregnancy was ruptured and a salpingectomy was performed by laparotomy. The intrauterine pregnancy progressed uneventfully. The two healthy babies were delivery by cesarean section at 36 ± 2 weeks of gestation. Heterotopic triplets with ruptured tubal ectopic pregnancy represent a special diagnostic and therapeutic challenge for the obstetrician. A high rate of clinical suspicion and timely treatment by laparotomy or laparoscopy can preserve the intrauterine gestation with a successful outcome of the pregnancy.

Key-words heterotopic pregnancy Multiple pregnancy obstetrical surgery Pregnancy complications tubal pregnancy
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Original Article08-26-2020

Maternal and Sociodemographic Factors Influence the Consumption of Ultraprocessed and Minimally-Processed Foods in Pregnant Women
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(7):380-389

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Abstract
Original Article
Maternal and Sociodemographic Factors Influence the Consumption of Ultraprocessed and Minimally-Processed Foods in Pregnant Women
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(7):380-389
DOI 10.1055/s-0040-1712996
Monique Tavares Pereira ,
Monica Cattafesta ,
Edson Theodoro dos Santos Neto ,
Luciane Bresciani Salaroli
Views197
Abstract

Objective

To analyze the consumption of minimally-processed and ultraprocessed foods in relation with sociodemographic variables, maternal habits, educational activity received during prenatal care and clinical history.

Methods

A cross-sectional, analytical and descriptive study with 1,035 pregnant women who lives in the municipalities of the metropolitan region of Grande Vitória, Espírito Santo, Brazil (RMGV-ES), and who were hospitalized in establishments of the Unified Health System (SUS) due to childbirth (April-September 2010). The food frequency questionnaire, pregnant woman’s card and information from the medical records of the health facility unit were analyzed. The Chi-square test and the binary logistic regression model were used to investigate the association between the independent variables and the consumption of ultraprocessed foods.

Results

It was identified that pregnant women ≤ 19 years of agewere 2.9 timesmore likely to consume ultraprocessed foods (confidence interval [CI] 95% 1.683-5.168, p< 0.001), while those ≥ 35 years old were less likely to consume them (odds ratio [OR] 0.265, 95% CI 0.105-0.666, p= 0.005). Maternal smoking increased the odds of consumption of ultraprocessed foods by 2.2 times (95% CI 1.202-4.199, p= 0.011) and pregnant womenwho did not obtain information on healthy food during prenatal care presented 54.1% less chances of consuming minimally-processed foods (OR 0.459, 95% CI 0.307-0.687, p< 0.001).

Conclusion

Smoking during the gestational period and being a teenager are factors that influence the consumption of ultraprocessed foods of pregnant women. Race/ color, head of household, age group, receiving of information about feeding in the prenatal period and not having smoked in gestation determined the consumption of minimally-processed foods.

Key-words dietary habits Feeding behavior Maternal nutrition pregnant ultraprocessed foods
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Original Article01-12-2021

Association of Overweight and Consistent Anovulation among Infertile Women with Regular Menstrual Cycle: A Case-control Study
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(11):834-839

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Abstract
Original Article
Association of Overweight and Consistent Anovulation among Infertile Women with Regular Menstrual Cycle: A Case-control Study
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(11):834-839
DOI 10.1055/s-0041-1739464
Christiane Ricaldoni Giviziez ,
Eliane Gouveia de Morais Sanchez ,
Yanna Andressa Ramos de Lima ,
Mário Silva Approbato
Views202
Abstract

Objective

It has been suggested that excess body weight could represent a risk factor for infertility outcomes. The present study aimed to evaluate the association of overweight and anovulation among infertile women with regular menstrual cycles.

Methods

We conducted a retrospective case-control study with consistently anovulatory patients undergoing assisted reproduction treatment. The patients were stratified into normal weight (body mass index [BMI]: 18.5-24.9kg/m2) and overweight (BMI: 25.0- 29.9kg/m2).Those with polycystic ovary syndrome or obesity were excluded. The groups were matched for age, duration of infertility, prolactin, follicle stimulating hormone (FSH), thydroid stimulating hormone (TSH), luteinizing hormone (LH), and estradiol levels.

Results

Overweight was significantly associated with anovulation, when using the World Health Organization (WHO) criteria for anovulation: progesterone levels>5.65 ng/ml and ultrasonography evidence of follicle collapse (odds ratio [OR]: 2.69; 95% confidence interval [CI95%]: 1.04-6.98).

Conclusion

Body mass index above the normal range jeopardizes ovulation among non-obese infertile women with regular menstrual cycles.

Key-words Anovulation Assisted reproductive techniques female infertility Overweight
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Original Article03-11-2022

Cervical Intraepithelial Neoplasia: Analyzing the Disease Present Exclusively in the Endocervical Canal
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(4):385-390

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Abstract
Original Article
Cervical Intraepithelial Neoplasia: Analyzing the Disease Present Exclusively in the Endocervical Canal
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(4):385-390
DOI 10.1055/s-0042-1743102
Fernanda Villar Fonseca ,
Maria Victória Gutierrez Cordeiro ,
Ariadne Cristine Pozza ,
Carlos Afonso Maestri
Views200
Abstract

Objective

To evaluate the role of cervical cytology (Pap smear) in the diagnosis of cervical intraepithelial neoplasia 2 or greater (CIN2+), presented exclusively in the endocervical canal, the clinical-epidemiological characteristics of this lesion, the necessary length of canal to be removed to treat, and the rate of invasive lesion hidden in the endocervical canal.

Methods

Cross-sectional study, by database analysis, of patients with abnormal cytology (high-grade squamous intraepithelial lesion [HSIL]), without visible colposcopy lesion, submitted to loop electrosurgical procedure (LEEP) to evaluate the association of cytology results with the histological product of the conization, to identify the epidemiological characteristics of endocervical lesion and clinical evolution, using a pvalue< 0.05 and 95% CI.

Results

In 444 cases, the Pap smear sensitivity for CIN2+ diagnosis was 75% (95% CI: 69.8-79.7), specificity was 40% (95% CI: 30.2-49.5), and the prevalence rate of histological lesion was 73% (95% CI: 70.1-78.7). There was a higher prevalence of CIN2+ in women over 42 years old and invasive cancer in those over 56 years old (p<0.001), and it was necessary to remove 2.6 cm in length of the canal to reduce the chance of recurrence (p<0.006). The rate of invasive cancer was 2.7%.

Conclusion

Cytology was related to a high prevalence to histological lesion (73%) in the diagnosis of CIN2+ in the endocervical disease; older patients presented a higher relationship with histological lesions in the canal disease, and it was necessary to remove an average of 2.6 cm in length of the endocervical canal to avoid the persistence and progression of CIN. The rate of occult neoplasia in the endocervical canal was 2.7%.

Key-words Cervical intraepithelial neoplasia CIN oncotic cytology
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Review Article12-11-2023

Prognostic Impact of AGR3 Protein Expression in Breast Cancer: A Systematic Review and Meta-analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(10):609-619

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Abstract
Review Article
Prognostic Impact of AGR3 Protein Expression in Breast Cancer: A Systematic Review and Meta-analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(10):609-619
DOI 10.1055/s-0043-1772183
Carolina Leão de Moraes ,
Carolina Rodrigues Mendonça ,
Natália Cruz e Melo ,
Fernanda Sardinha de Abreu Tacon ,
Jair Pereira de Melo Junior ,
Waldemar Naves do Amaral
Views201
Abstract

Objective

To investigate the clinicopathological significance and prognosis of the expression of the anterior gradient 3 (AGR3) protein in women with breast cancer.

Data Sources

The PubMed, CINAHL, EMBASE, Scopus, and Web of Science databases were searched for studies published in English and without restrictions regarding the year of publication. The search terms were: breast cancer AND anterior gradient 3 OR AGR3 expression.

Study Selection

We included observational or interventional studies, studies on AGR3 protein expression by immunohistochemistry, and studies on invasive breast cancer. Case reports, studies with animals, and reviews were excluded. In total, 4 studies were included, containing 713 cases of breast cancer.

Data Collection

Data were extracted on clinicopathological characteristics and survival. A meta-analysis of the prevalence of AGR3 expression was performed according to the clinicopathological characteristics, hazard ratios (HRs), and overall survival and disease-free survival.

Data Synthesis

The expression of AGR3 was found in 62% of the cases, and it was associated with histological grade II, positivity of estrogen and progesterone receptors, low expression of ki67, recurrence or distant metastasis, and lumen subtypes. In patients with low and intermediate histological grades, AGR3 expression was associated with worse overall survival (HR: 2.39; 95% confidence interval [95%CI]: 0.628–4.159; p = 0.008) and worse disease-free survival (HR: 3.856; 95%CI: 1.026–6.686; p = 0.008).

Conclusion

The AGR3 protein may be a biomarker for the early detection of breast cancer and predict prognosis in luminal subtypes. In addition, in patients with low and intermediate histological grades, AGR3 protein expression may indicate an unfavorable prognosis in relation to survival.

Key-words Breast neoplasms human AGR3 protein Immunohistochemistry Prognosis survival
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Original Article10-01-2017

Clinical Characteristics in a Sample of Transsexual People
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(10):545-551

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Abstract
Original Article
Clinical Characteristics in a Sample of Transsexual People
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(10):545-551
DOI 10.1055/s-0037-1604134
Maria Rita Lerri,
Adriana Peterson Mariano Salata Romão,
Manoel Antônio dos Santos,
Alain Giami,
Rui Alberto Ferriani,
Lúcia Alves da Silva Lara
Views208
Abstract

Purpose

To assess the clinical characteristics of subjects with gender dysphoria (GD).

Method

A cross-sectional study of adults with GD. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Sociodemographic data, clinical data and life habits were recorded.

Results

Total of 44 subjects participated in the study: 36 (82%) trans women and 8 (18%) trans men. Forty-three (98%) of the GD patients had anxiety (36 [100%] trans women and 7 [87.5%] trans men), and 36 (82%) had depression (29 [80.5%] trans women and 7 [87.5%] trans men). Suicide had been attempted by 32 (73%) subjects. The rates of depression were lower among the subjects living with partners, parents, or other people than among those living alone (p = 0.03), and it was also lower among the subjects who were married compared to those who were dating or single (p = 0.03).

Conclusion

Improving the relationship status may reduce the prevalence of depressive symptoms in GD patients. There was a high rate of attempted suicide in this sample.

Key-words Anxiety Depression gender dysphoria sex reassignment surgery transsexual
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Review Article09-18-2024

Immunosuppressants in women with repeated implantation failure in assisted reproductive techniques: a systematic review and meta-analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo70

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Abstract
Review Article
Immunosuppressants in women with repeated implantation failure in assisted reproductive techniques: a systematic review and meta-analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo70
DOI 10.61622/rbgo/2024rbgo70
Ana Clara Felix de Farias Santos ,
Fernanda Valeriano Zamora ,
Lubna Al-Sharif ,
Kush Sehgal ,
Deyvid Vieira Silva Cavalcante ,
Sarah Hasimyan Ferreira ,
Pedro Henrique Costa Matos da Silva
Views307
Abstract

Objective

To compare outcomes in patients with repeated implantation failure undergoing Intracytoplasmic Sperm Injection/In vitro fertilization (IVF/ICSI) plus immunosuppressants such as prednisolone, prednisone, or cyclosporine A versus the use of IVF/ICSI alone.

Data source

Databases were systematically searched in PubMed, Cochrane, and Embase databases in September 2023.

Study Selection

Randomized clinical trials and observational studies with the outcomes of interest were included.

Data collect

We computed odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics. Data were analyzed using Review Manager 5.4.The main outcomes were live birth, miscarriage, implantation rate, clinical pregnancy, and biochemical pregnancy.

Data synthesis

Seven studies with 2,829 patients were included. Immunosuppressive treatments were used in 1,312 (46.37%). Cyclosporine A improved implantation rate (OR 1.48; 95% CI 1.01-2.18) and clinical pregnancy (1.89, 95% CI 1.14-3.14). Compared to non-immunosuppressive treatment, prednisolone and prednisone did not improve live birth (OR 1.13, 95% CI 0.88-1.46) and miscarriage (OR 1.49, 95% CI 1.07-2.09). Prednisolone showed no significant effect in patients undergoing IVF/ICSI, clinical pregnancy (OR 1.34; 95% CI 0.76-2.36), or implantation rate (OR 1.36; 95% CI 0.76-2.42).

Conclusion

Cyclosporine A may promote implantation and clinical pregnancy rates. However, given the limited sample size, it is important to approach these findings with caution. Our results indicate that prednisolone and prednisone do not have any beneficial effects on clinical outcomes of IVF/ICSI patients with repeated implantation failure.

PROSPERO

CRD42023449655

Key-words Cyclosporine A Prednisolone Immunosupressive agents Prednisone Repeated implantation failure Reproduction Reproductive techniques, assisted
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Original Article06-19-2019

Health-related Quality of Life in Women with Cervical Cancer
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(4):242-248

Views249

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
Health-related Quality of Life in Women with Cervical Cancer
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(4):242-248
DOI 10.1055/s-0039-1683355
Larissa Nascimento dos Santos,
Luciana Castaneda ,
Suzana Sales de Aguiar,
Luiz Claudio Santos Thuler,
Rosalina Jorge Koifman,
Anke Bergmann
Views249
Abstract

Objective

To analyze the factors associated with health-related quality of life (HRQoL) in women with cervical cancer (CC) in a single center in Rio de Janeiro, state of Rio de Janeiro, Brazil.

Methods

A cross-sectional study in women with a diagnosis of CC followed-up in the gynecology outpatient clinic of the Hospital do Câncer II (HCII, in the Portuguese acronym) of the Instituto Nacional de Câncer (INCA, in the Portuguese acronym). The data were collected from March to August 2015. Women with palliative care, communication/cognition difficulty, undergoing simultaneous treatment for other types of cancer, or undergoing chemotherapy and/or radiation therapy were excluded. For the evaluation of the HRQoL, a specific questionnaire for women with CC was used (Functional Assessment of Cancer Therapy – Cervix Cancer [FACT-Cx]). The total score of the questionnaire ranges from 0 to 168, with higher scores indicating a better HRQoL.

Results

A total of 115 women were included in the present study, with a mean age of 52.64 years old (standard deviation [SD] = 12.13). The domains of emotional (16.61; SD = 4.55) and functional well-being (17.63; SD = 6.15) were those which presented the worst scores. The factors that had an association with better HRQoL in women with CC were having a current occupation, a longer time since the treatment and diagnosis, and women who had undergone hysterectomy.

Conclusion

Considering the domains of HRQoL of the women treated for cervical cancer, a better score was observed in the domains of physical and social/family wellbeing. For most domains, better scores were found between those with a current occupation, with a longer time after the diagnosis and treatment, and among those who had undergone a hysterectomy.

Key-words Cross-sectional studies data collection Quality of life Uterine cervical neoplasms
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Review Article06-01-2018

Guidelines for HPV-DNA Testing for Cervical Cancer Screening in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(6):360-368

Views368

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
Guidelines for HPV-DNA Testing for Cervical Cancer Screening in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(6):360-368
DOI 10.1055/s-0038-1657754
Luiz Carlos Zeferino,
Joana Bragança Bastos,
Diama Bhadra Andrade Peixoto do Vale,
Rita Maria Zanine,
Yara Lucia Mendes Furtado de Melo,
Walquíria Quida Salles Pereira Primo,
Flávia de Miranda Corrêa,
Isabel Cristina Chulvis do Val,
Fábio Russomano
Views368
Abstract

Evidence-based clinical guidelines ensure best practice protocols are available in health care. There is a widespread use of human papillomavirus deoxyribonucleic acid (HPVDNA) tests in Brazil, regardless of the lack of official guidelines. On behalf of the Brazilian Association for the Lower Genital Tract Pathology and Colposcopy (ABPTGIC, in the Portuguese acronym), a team of reviewers searched for published evidence and developed a set of recommendations for the use of HPV-DNA tests in cervical cancer screening in Brazil. The product of this process was debated and consensus was sought by the participants. One concern of the authors was the inclusion of these tests in the assessment of women with cytologic atypia and women treated for cervical intraepithelial neoplasia (CIN). Testing for HPV is recommended in an organized screening scenario to identify women with precursor lesions or asymptomatic cervical cancer older than 30 years of age, and it can be performed every 5 years. It also has value after the cytology showing atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSILs) as a triage test for colposcopy, in the investigation of other cytological alterations when no abnormal findings are observed at colposcopy, seeking to exclude disease, or, further, after treatment of high-grade cervical intraepithelial neoplasia, to rule out residual disease.

Key-words Cervical intraepithelial neoplasia cervical neoplasms Cytology DNA-HPV probes Screening
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Original Article06-22-2020

Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio in Missed Abortion
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(5):235-239

Views251

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Abstract
Original Article
Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio in Missed Abortion
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(5):235-239
DOI 10.1055/s-0040-1709693
Ismail Biyik ,
Mustafa Albayrak ,
Fatih Keskin
Views251
Abstract

Objective

Missed abortion occurs in ~ 15% of all clinical pregnancies. The pathogenesis is not clearly known. However, defective placentation resulting in maternal systemic inflammatory response is considered responsible for missed abortion. Platelet lymphocyte ratio (PLR) and neutrophil lymphocyte ratio (NLR) are increasingly cited parameters of inflammation in the literature. However, no study evaluated the PLR and NLR rates in missed abortions so far. The aim of the present study is to investigate whether complete blood count (CBC) inflammatory parameters such as NLR and PLR are increased in patients with missed abortion.

Methods

Medical records of 40 pregnant women whose gestation ended in missed abortion at between 6 and14 weeks of gestation and of 40 healthy pregnant women were collected and compared retrospectively. The groups were compared regarding hemoglobin, hematocrit, platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), PLR and NLR.

Results

Platelet distribution width, NLR and PLR values were higher in the missed abortion group compared with the healthy pregnant women group (rates are p = 0.043; p = 0.038; and p = 0.010, respectively). Hematocrit, MPV, and lymphocyte values were found to be lower in the missed abortion group compared with the healthy pregnant women group (p = 0.027, p = 0.044 and p = 0.025, respectively).

Conclusion

The PDW, NLR and PLR values of the missed abortion group were reported high; and MPV values were reported low in the present study. These ﬁndings may help to speculate a defective placentation in the pathogenesis of missed abortion.

Key-words missed abortion neutrophil to lymphocyte ratio inflammation platelet to lymphocyte ratio
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Original Article11-01-2018

Comparative Study of the Use of HPA Lanolin and Breast Milk for Treating Pain Associated with Nipple Trauma
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(11):664-672

Views270

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
Comparative Study of the Use of HPA Lanolin and Breast Milk for Treating Pain Associated with Nipple Trauma
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(11):664-672
DOI 10.1055/s-0038-1675180
Corintio Mariani Neto,
Rosemeire Sartori de Albuquerque,
Sonia Cristina de Souza,
Renata Oliveira Giesta,
Andrea Penha Spinola Fernandes,
Bárbara Mondin
Views270
Abstract

Objective

To compare two different treatments—the use of highly purified anhydrous (HPA) lanolin and expressed breast milk—for women with pain and nipple trauma during the breastfeeding process.

Method

A total of 180 puerperal women were randomly assigned to 2 groups: one was treated with HPA lanolin and the other with their own expressed breast milk. All of the participants received the same breastfeeding technique instructions and therapeutic care standard. Three assessments were performed: at the time of inclusion in the study (after randomization); after 48 hours; and after 7 days. At each interval, data was collected in relation to pain and trauma. A numerical/verbal category scale was used for the pain variable, and the nipple trauma score for the trauma variable. The results were subjected to statistical analysis using the chi-squared test, the Fisher exact test, the student t-test, and the Kolmogorov-Smirnov test. Generalized estimating equations were calculated using the STATA 12 statistical software package (StataCorp LLC, College Station, TX, USA) and IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp, Armonk, NY, USA).

Results

There was pain improvement from the second to the third assessment in the group that used HPA lanolin, while the pain remained unchanged between these two periods (p< 0.001) in the breast milk group. In terms of trauma, improvement was identified in its extension and depth from the first to the third assessment, and it was higher in the HPA lanolin group than in the breast milk group (p= 0.025).

Conclusion

The treatment of pain and nipple trauma with HPA lanolin achieved better results than the one with breast milk, based on a 7-day treatment period.

Key-words breastfeeding/adverse effects breastfeeding/nipple pain lanolin/therapeutic use nipples/injuries wound healing/drug effects
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Review Article11-07-2019

Antiphospholipid Antibody Syndrome and Infertility
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(10):621-627

Views275

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
Antiphospholipid Antibody Syndrome and Infertility
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(10):621-627
DOI 10.1055/s-0039-1697982
Vivian de Oliveira Rodrigues,
Adriana de Góes e Silva Soligo,
Gabriel Duque Pannain
Views275
Abstract

Antiphospholipid antibody syndrome (APS) is a systemic, autoimmune, prothrombotic disease characterized by persistent antiphospholipid antibodies (aPLs), thrombosis, recurrent abortion, complications during pregnancy, and occasionally thrombocytopenia. The objective of the present study was to review the pathophysiology of APS and its association with female infertility. A bibliographic review of articles of the past 20 yearswas performed at the PubMed, Scielo, and Bireme databases. Antiphospholipid antibody syndrome may be associated with primary infertility, interfering with endometrial decidualization and with decreased ovarian reserve. Antiphospholipid antibodies also have direct negative effects on placentation, when they bind to the trophoblast, reducing their capacity for invasion, and proinflammatory effects, such as complement activation and neutrophil recruitment, contributing to placental insufficiency, restricted intrauterine growth, and fetal loss. In relation to thrombosis, APS results in a diffuse thrombotic diathesis, with global and diffuse dysregulation of the homeostatic balance. Knowing the pathophysiology of APS, which is closely linked to female infertility, is essential for new therapeutic approaches, specialized in immunomodulation andinflammatory signaling pathways, to provide important advances in its treatment.

Key-words antiphospholipid antibody antiphospholipid antibody syndrome Infertility Recurrent abortion
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Original Article03-27-2020

Gestational Diabetes in the Population Served by Brazilian Public Health Care. Prevalence and Risk Factors
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(1):12-18

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Abstract
Original Article
Gestational Diabetes in the Population Served by Brazilian Public Health Care. Prevalence and Risk Factors
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(1):12-18
DOI 10.1055/s-0039-1700797
Pâmela Antoniazzi dos Santos ,
José Mauro Madi ,
Emerson Rodrigues da Silva ,
Daiane de Oliveira Pereira Vergani ,
Breno Fauth de Araújo ,
Rosa Maria Rahmi Garcia
Views340
Abstract

Objective

To assess the prevalence of gestational diabetes mellitus and the main associated risk factors in the population served by the Brazilian Unified Health System in the city of Caxias do Sul, state of Rio Grande do Sul.

Materials and Methods

A descriptive, cross-sectional and retrospective study was conducted. Maternal variables were collected from the medical records of all pregnant women treated at the basic health units in 2016. Hyperglycemia during pregnancy (pregestational diabetes, overt diabetes and gestational diabetes mellitus) was identified by analyzing the results of a 75-g oral glucose tolerance test, as recommended by the Brazilian Ministry of Health. Based on the data, the women were allocated into two groups: the gestational diabetes group and the no gestational diabetes group.

Results

The estimated prevalence of gestational diabetes among 2,313 pregnant women was of 5.4% (95% confidence interval [95%CI]: 4.56-6.45). Pregnant women with 3 or more pregnancies had twice the odds of having gestational diabetes compared with primiparous women (odds ratio [OR]=2.19; 95%CI: 1.42-3.37; p<0.001). Pregnant women aged 35 years or older had three times the odds of having gestational diabetes when compared with younger women (OR=3.01; 95%CI: 1.97-4.61; p<0.001). Overweight pregnant women were 84% more likely to develop gestational diabetes than those with a body mass index lower than 25 kg/m2 (OR =1.84; 95%CI: 1.25-2.71; p=0.002). A multivariable regression analysis showed that being overweight and being 35 years old or older were independent variables.

Conclusion

In this population, the prevalence of gestational diabetes mellitus was of 5.4%. Age and being overweight were predictive factors for gestational diabetes.

Key-words Gestational diabetes maternal health Prevalence Public health
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Original Article09-01-2018

Urinary Incontinence and Quality of Life in Female Patients with Obesity
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(9):534-539

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Abstract
Original Article
Urinary Incontinence and Quality of Life in Female Patients with Obesity
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(9):534-539
DOI 10.1055/s-0038-1670626
Christiana Campani Nygaard,
Lucas Schreiner,
Thiago Picolli Morsch,
Rodrigo Petersen Saadi,
Marina Faria Figueiredo,
Alexandre Vontobel Padoin
Views193
Abstract

Objective

To analyze the prevalence of urinary incontinence (UI) in female patients with an indication for bariatric surgery, to investigate the potential risk factors and the impact on quality of life.

Methods

A cross-sectional study with female patients with obesity. The evaluation consisted of a structured interview, a specific study form and quality of life questionnaires. The Poisson regression was performed to identify independent risk factors related to UI.

Results

A total of 221 patients were enrolled; 118 of the study participants (53.4%) reported UI episodes. Mixed UI (MUI), stress UI (SUI) only, and urgency UI (UUI) only were reported by 52.5% (62), 33.9% (40) , and 13.5% (16) of these patients respectively. The prevalence of UI was increased by 47% among the women who had given birth vaginally and by 34% of the women who had entered menopause. Vaginal delivery and menopause were identified as independent risk factors related to UI. The mean International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF) score was 9.36 ± 4.9. The severity of symptoms was considered moderate in 53.3% (63) of the patients with UI.

Conclusion

Urinary incontinence impacts quality of life negatively, and the prevalence of UI is high among obese patients. In the present study, vaginal delivery and menopause were independently associated with UI.

Key-words Bariatric surgery Obesity Urinary incontinence
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Original Article03-04-2022

Screening of Perinatal Depression Using the Edinburgh Postpartum Depression Scale
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(5):452-457

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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
Screening of Perinatal Depression Using the Edinburgh Postpartum Depression Scale
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(5):452-457
DOI 10.1055/s-0042-1743095
Tenilson Amaral Oliveira ,
Guilherme Guarany Cardoso Magalhães Luzetti ,
Márcia Maria Auxiliadora Rosalém ,
Corintio Mariani Neto
Views489
Abstract

Objective

To detect depression during pregnancy and in the immediate postpartum period using the Edinburgh postpartum depression scale (EPDS).

Methods

Cross sectional study of 315 women, aged between 14 and 44 years, who received perinatal care at the Leonor Mendes de Barros Hospital, in São Paulo, between July 1st, 2019 and October 30th, 2020. The cutoff point suggesting depression was ≥ 12.

Results

The screening indicated 62 (19.7%) patients experiencing depression. Low family income, multiparity, fewer prenatal appointments, antecedents of emotional disorders, dissatisfaction with the pregnancy, poor relationship with the partner, and psychological aggression were all risk factors associated with depression in pregnancy or in the immediate postpartum period. Antecedents of depression and psychology aggression during pregnancy were significant variables for predicting perinatal depression in the multivariate analysis.

Conclusion

There is a significant association between the occurrence of perinatal depression and the aforementioned psychosocial factors. Screening patients with the EPDS during perinatal and postpartum care could facilitate establishing a line of care to improve the wellbeing of mother and infant.

Key-words Depression Postpartum period Pregnancy Prenatal care Risk factors
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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

Valor da histerossonografia na avaliação da cavidade endometrial na mulher com sangramento uterino anormal

Freqüência de mutação no códon 12 do gene K-ras no carcinoma ductal invasivo de mama, através da técnica da reação em cadeia da polimerase

Vaginal hysterectomy: is the laparoscope necessary?

The Burden of Indirect Causes of Maternal Morbidity and Mortality in the Processof Obstetric Transition: A Cross-Sectional Multicenter Study

Abstract

Objective

Methods

Results

Conclusion

Spontaneous Heterotopic Triplet Pregnancy with a Two Viable Intrauterine Embryos and an Ectopic One with Right Tubal Rupture

Abstract

Maternal and Sociodemographic Factors Influence the Consumption of Ultraprocessed and Minimally-Processed Foods in Pregnant Women

Abstract

Objective

Methods

Results

Conclusion

Association of Overweight and Consistent Anovulation among Infertile Women with Regular Menstrual Cycle: A Case-control Study

Abstract

Objective

Methods

Results

Conclusion

Cervical Intraepithelial Neoplasia: Analyzing the Disease Present Exclusively in the Endocervical Canal

Abstract

Objective

Methods

Results

Conclusion

Prognostic Impact of AGR3 Protein Expression in Breast Cancer: A Systematic Review and Meta-analysis

Abstract

Objective

Data Sources

Study Selection

Data Collection

Data Synthesis

Conclusion

Clinical Characteristics in a Sample of Transsexual People

Abstract

Purpose

Method

Results

Conclusion

Immunosuppressants in women with repeated implantation failure in assisted reproductive techniques: a systematic review and meta-analysis

Abstract

Objective

Data source

Study Selection

Data collect

Data synthesis

Conclusion

PROSPERO

Health-related Quality of Life in Women with Cervical Cancer

Abstract

Objective

Methods

Results

Conclusion

Guidelines for HPV-DNA Testing for Cervical Cancer Screening in Brazil

Abstract

Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio in Missed Abortion

Abstract

Objective

Methods

Results

Conclusion

Comparative Study of the Use of HPA Lanolin and Breast Milk for Treating Pain Associated with Nipple Trauma

Abstract

Objective

Method

Results

Conclusion

Antiphospholipid Antibody Syndrome and Infertility

Abstract

Gestational Diabetes in the Population Served by Brazilian Public Health Care. Prevalence and Risk Factors