Articles - Revista Brasileira de Ginecologia e Obstetrícia

Original Article07-10-2000

Analysis of Avoidable Mortality Among Women in Reproductive Age
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(9):579-584

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Abstract
Original Article
Analysis of Avoidable Mortality Among Women in Reproductive Age
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(9):579-584
DOI 10.1590/S0100-72032000000900007
Mary Angela Parpinelli,
Aníbal Faúndes,
José Guilherme Cecatti,
Belmiro Gonçalves Pereira,
Renato Passini Júnior,
Eliana Amaral
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Purpose: to evaluate the avoidable mortality among women in reproductive age, living in Campinas, SP, comparing two five-year periods: 1985-89 and 1990-94. Methods: death certificates of 3.086 women aged 10 to 49 years were studied, representing the total number of deaths during the period from January 1985 through December 1994. The criteria for avoidance were applied to these deaths using preventive, sanitary, early diagnosis and treatment, and mixed measures. The deaths were also classified as: with hardly avoidable causes, not well-defined causes and other causes. The specific mortality coefficient for each period of five years and the ratio between these coefficients were calculated. Results: there was a 20% increase in the avoidable mortality rate from the first to the second period. The main failure was observed among the group of avoidable causes by preventive and sanitary measures. The main increase in death causes by preventive measures resulted from AIDS. Among the causes of death avoidable by mixed measures, the increase of 50% in maternal mortality caused by abortion, as well as causes due to violence specially homicides, are emphasized. Conclusion: there was an increase in the proportion of avoidable death causes. Measures to prevent AIDS, abortion and to reduce violent deaths, specially homicides, should be political and social priorities in our Country.

Key-words AIDS Avoidable mortality Reproductive health Women mortality
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Original Article07-10-2000

Treatment of Eclampsia: Comparative Study on the Use of Magnesium Sulfate and Phenytoin
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(9):543-549

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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
Treatment of Eclampsia: Comparative Study on the Use of Magnesium Sulfate and Phenytoin
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(9):543-549
DOI 10.1590/S0100-72032000000900002
João de Deus Valadares Neto,
Anna Maria Bertini,
Wladimir Corrêa Taborda,
Joaquim Vaz Parente
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Purpose: to compare the efficiency between magnesium sulfate and phenytoin in the control of convulsions in patients with eclampsia and to evaluate the effects of magnesium sulfate and phenytoin on the maternal and perinatal prognosis in patients with eclampsia. Methods: this is a prospective, randomized and controlled study in which the results obtained with the use of anticonvulsive treatment in 77 women with eclampsia, treated with either magnesium sulfate or phenytoin, were analyzed comparatively. The drugs which were used in both therapeutic schemes were distributed in a one to one ratio, in randomly numbered boxes which presented similar characteristics. When a patient was admitted, a box was opened and its contents were given to the patient. Results: in the group whose patients were treated with magnesium sulfate, 19.5% had recurrent convulsions while in the group whose patients used phenytoin, 36.1% had new crises (p<0,05). The patients who were treated with magnesium sulfate showed a greater prevalence of postpartum hemorrhage (14,7%) than those to whom phenytoin was administered (2.7%) (p<0.05). In relation to the newborns, 17.0% of the group from mothers treated with magnesium sulfate presented respiratory distress as opposed to the group of newborns from mothers treated with phenytoin (11.8%), (p> 0,05). Conclusion: magnesium sulfate is shown to be more efficient than phenytoin in the control and the prevention of convulsions in patients with eclampsia. However, its utilization showed a higher prevalence of postpartum hemorrhage and respiratory distress. Phenytoin should be used in cases where the use of magnesium sulfate is contraindicated.

Key-words Eclampsia Hypertension Magnesium sulfate Phenytoin Puerperium Respiratory distress syndrome
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Recadastramento de Sócios
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(9):541-541

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Abstract
Recadastramento de Sócios
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(9):541-541
DOI 10.1590/S0100-72032000000900001
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Recadastramento de Sócios […]
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Original Article07-04-2003

Treatment of bacterial vaginosis with Schinus terebinthifolius Raddi vaginal gel: a randomized controlled trial
- Melania Maria Ramos de Amorim,
- Luiz Carlos Santos
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(2):95-102

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Abstract
Original Article
Treatment of bacterial vaginosis with Schinus terebinthifolius Raddi vaginal gel: a randomized controlled trial
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(2):95-102
DOI 10.1590/S0100-72032003000200004
Melania Maria Ramos de Amorim,
Luiz Carlos Santos
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PURPOSE: to test the efficacy of and tolerance to Schinus terebinthifolius Raddi gel in the treatment of bacterial vaginosis. METHODS: forty-eight women with symptomatic bacterial vaginosis (according to Amsel’s criteria) were enrolled in a randomized, double-blind, controlled trial comparing Schinus terebinthifolius Raddi gel (25 cases) with placebo (23 cases). The main outcome parameters were: rate of cure, presence of lactobacilli in Pap smear after treatment and side effects. Statistical analysis was performed using the chi2 and the Fisher exact test at 5% level of significance. RESULTS: using Amsel’s clinical parameters of bacterial vaginosis, the cure rate was 84% in the Schinus group and 47.8% in the placebo group (p=0.008). A significant increase in the frequency of lactobacilli was observed in the Pap smear of the group treated with Schinus (43.5%) compared to the patient group (4.3%) (p=0.002). Treatment-related adverse events were not frequent in either group. CONCLUSIOS: the present study indicates that Schinus vaginal gel is effective and safe in the treatment of bacterial vaginosis. In addition, potential beneficial effects on the vaginal flora are suggested.

Key-words Bacterial vaginosis Clinical trial Schinus Vaginal infections
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Original Article07-04-2003

Grading systems for breast carcinoma: comparative study of cytohistological agreement
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(2):87-94

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Abstract
Original Article
Grading systems for breast carcinoma: comparative study of cytohistological agreement
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(2):87-94
DOI 10.1590/S0100-72032003000200003
Karla Adriana Nascimento Dantas,
Gilda da Cunha Santos,
Osvaldo Giannotti Filho
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PURPOSE: to assess the concordance of cytological tumoral and nuclear grading systems on fine needle aspiration biopsies of breast carcinoma with histological specimens and compare them to identify the best results. METHODS: cytohistological agreement was evaluated in a retrospective study of 50 cases of fine needle aspiration biopsies of histologically confirmed invasive ductal carcinoma of the breast, with 5 grading systems being applied for comparative purposes.The classifications were divided according to criteria of tumoral grading (nuclear and architectural criteria – Mouriquand and Guilford systems) and nuclear criteria (Black modified by Fisher (BM), simplified Black system (SB) and Hunt system). The grading systems used for histological analysis were those of Scarff-Bloom-Richardson modified by Elston (SBR modified) for tumor evaluation and the BM systems for nuclear evaluation. RESULT: the cytological grading systems that showed best agreement were BM and SB based on nuclear criteria (anisonucleosis, size, mitosis, and chromatin). Among the cytological grading systems based on nuclear and architectural criteria (combined), Guilford’s classification showed the best agreement, possibly due to the larger number of variables used, which permitted a smaller margin of error. CONCLUSION: the methods evaluated in the present study can be considered reasonable as cytological grading systems.

Key-words Breast carcinoma Fine needle aspiration Histological grading Nuclear grading
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Original Article07-04-2003

Cervical cancer precursor lesions in adolescent and young adult women of Rio Branco – Acre
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(2):81-86

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Abstract
Original Article
Cervical cancer precursor lesions in adolescent and young adult women of Rio Branco – Acre
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(2):81-86
DOI 10.1590/S0100-72032003000200002
Elaine Azevedo Soares Leal,
Osvaldo de Sousa Leal Júnior,
Maria Helena Guimarães,
Maria Nísia Vitoriano,
Talita Lima do Nascimento,
Olívia Lúcia N. Costa
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PURPOSE: to describe the frequency of precursor lesions of cervical cancer in 15 to 29-year-old women, associating the degree of damage with the epidemiologic characteristics and associated risk factors. METHODS: a transverse study was performed, where the precursor lesions of cervical cancer were investigated through Papanicolaou test in 15 to 29 year-old women with active sexual life, living in Rio Branco (AC), in the period from January to September 2001. The investigated data included epidemiologic information, risk factors and physical-ginecological examination results, including Schiller test and smears for cytopathologic test. RESULTS: of the 2,397 women studied, 155 (6.4%) showed some kind of cellular epithelial alteration, 146 (94.2%) squamous lesions and 9 (5.8%) glandular lesions. In 15 to 19 year old women, the frequency (6.9%) of cellular epithelial alteration was similar to that observed in 20 to 29-year-old women (p>0.65). These alterations were associated with low educational level (p<0.003), with the number of sexual partners (p<0.04), with STD history (p<0.001) and smoking habits (p<0.01). CONCLUSION: the high frequency of precursor lesions in an age lower than expected, and following an epidemiologic pattern observed in other phases of women's life, shows the early exposure to risk factors, which anticipates the development of cervical cancer.

Key-words Adolescent Cervical cancer NIC Papanicolaou Uterine cervix
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Tego: Valor Comercial?
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(2):79-79

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Abstract
Tego: Valor Comercial?
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(2):79-79
DOI 10.1590/S0100-72032003000200001
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EDITORIAL Tego – Valor Comercial? […]
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Resumos de Teses07-04-2003

Estudo exploratório: ultra-sonografia, ecocardiografia fetal e resultados perinatais em gestantes portadoras do HIV em uso de terapia anti-retroviral
- Marco Antonio Borges Lopes
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(2):136-136

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Abstract
Resumos de Teses
Estudo exploratório: ultra-sonografia, ecocardiografia fetal e resultados perinatais em gestantes portadoras do HIV em uso de terapia anti-retroviral
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(2):136-136
DOI 10.1590/S0100-72032003000200011
Marco Antonio Borges Lopes
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RESUMO DE TESE Estudo exploratório: ultra-sonografia, ecocardiografia fetal e resultados perinatais em gestantes portadoras do HIV em uso de terapia anti-retroviral […]
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Original Article06-19-2002

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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
Editorial
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(2):79-79
DOI 10.1590/S0100-72032002000200001
Views34
Editorial A Revista Brasileira de Ginecologia e Obstetrícia (RBGO), como já é do conhecimento de todos, é a única publicação na área de Ginecologia e Obstetrícia que está indexada mo SciELO (Scientific Electronic Library Online).[…]
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Original Article06-19-2002

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

Views106

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

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

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

Views124

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Original Article
Predictive Model using Risk Factors for Cesarean Section
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):21-28
DOI 10.1590/S0100-72032002000100004
Alfredo de Almeida Cunha,
Margareth Crisóstomo Portela,
Abés Mahomed Amed,
Luiz Camano
Views124
Purpose: to investigate antepartum factors related to cesarean section and develop a cesarean section predictive model. Methods: the study design was a retrospective cohort which included all the cared 843 deliveries in a third level unit from June 1993 through November 1994. Children with 1,000 g birthweight and above were included. The dependent variable was cesarean section (c-section). Independent variables were antepartum factors related to c-section. Logistic regression was used to develop a predictive model. Results: our model showed risk of c-section according to the following variables: maternal age under 20 years (OR = 0.396) and over 28 years (OR = 2.133); previous vaginal deliveries (OR = 0.626); previous c-section (OR = 4.576); prenatal care (OR = 2.346); breech presentation (OR = 4.174); twin pregnancies (OR = 14.065); late obstetrical hemorrhage (OR = 28.189); mild preeclampsia (OR = 2.180); severe preeclampsia OR=16.738; chronic hypertension OR=4.927 and other clinical problems (OR = 2.012). The predictive model had a concordance of 82.3% between probabilities and responses. Conclusions: our study identified 12 antepartum factors related to c-section. It was possible to develop a cesarean section predictive model taking into account all previously identified antepartum risk factors.

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

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

Views68

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

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

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

Views68

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Original Article
Maternal Serum Level of C-reactive Protein in Gestations Complicated by Preeclampsia
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):09-13
DOI 10.1590/S0100-72032002000100002
Antônio Carlos Vieira Cabral,
Janaína de Freitas Lázaro,
Zilma Nogueira Reis Vitral
Views68
Purpose: to investigate the association between serum C-reactive protein concentration and preeclampsia occurrence, as well as its relation to the disease severity. Patients and Methods: twenty-seven preeclamptic pregnant women and 27 pregnant women with no clinical intercurrences, in the third trimester of pregnancy, were evaluated in a transversal case-control study. Serum C-reactive protein dosage, besides clinical examination and laboratory tests for the diagnosis of the disease, were performed in the antenatal period. The association between C-reactive protein and the presence of preeclampsia, and the correlation between plasma protein values and blood pressure values were investigated. The chi² significance test and regression analysis through the square minimum technique were used, and the results were considered to be statistically significant when p<0.05. Results: the preeclamptic pregnant women presented mean blood pressure levels higher than their controls (129.9±12.1 and 87.2±6.5 mmHg, respectively) and significantly higher C-reactive protein mean values than the normotensive women (18.9±4.9 and 1.56±0.8 mg/L, respectively). There was a significant association between the C-reactive protein concentration increase and preeclampsia occurrence (p<0.0001, odds ratio: 20.1). It was also observed that the mean arterial pressure and proteinuria presented a direct correlation with the circulating C-reactive protein in maternal blood (p=0.001 and p<0.001, respectively). Conclusion: C-reactive protein is an effective marker of preeclampsia occurrence and significantly correlates with the disease severity. The use of this test for the differential diagnosis of pregnant women in several hypertensive situations and its utilization as a marker of preeclampsia prognosis deserve further studies.

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

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

Views92

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

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

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

Views68

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Original Article
Role of Clinical History and Physical Examination in the Diagnosis of Urinary Incontinence
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(2):87-91
DOI 10.1590/S0100-72032002000200003
Paulo Cezar Feldner Jr,
Leonardo Robson P.S. Bezerra,
Manoel João Bastista C. Girão,
Rodrigo Aquino de Castro,
Marair Gracio F. Sartori,
Edmund Chada Baracat,
Geraldo Rodrigues de Lima
Views68
Purpose: to analyze the prevalence of urogynecological symptoms and their relationship with final urodynamic diagnosis, and to compare the clinical sign of stress urinary incontinence with urodynamic diagnosis. Methods: a total of 114 patients were included in a retrospective study from June 2000 to January 2001. All patients were evaluated through medical interview, physical examination and urodynamic study. They were classified according to clinical symptom, presence of clinical sign of urine loss and urodynamic study. The data analysis was performed using a test to determine sensitivity, specificity, and positive and negative predictive values. Results: the mean age was 51 years (19-80), 61 patients (53.5%) were in menacme and 53 (46.5%) in postmenopausal stage. Ten (18.8%) were using hormone replacement therapy and 25 (21.9%) had been submitted to surgery for incontinence. The isolated clinical symptom of urine loss was reported in 41 (36.0%) patients, the isolated urgency/urgency-incontinence in 13 (11.4%) and mixed symptoms in 60 (52.6%). In the urodynamic study, of all patients with symptom of isolated urine loss, 34 (83%) had stress urinary incontinence (SUI), no patient had detrusor instability (DI), 2 (4.9%) had mixed incontinence (MI) and 5 (12.1%) had a normal result. Of all patients with isolated urgency/urgency-incontinence, in the urodynamic study, none had SUI, 5 (38.5%) had ID, 1 (7.7%) had MI and 7 (53.8%) had a normal result. Of the patients with mixed symptoms, we identified, on the urodynamic evaluation, 25 (41.6%) who had SUI, 10 (16.7%) ID, 10 (16.7%) MI and 15 (25.0%) a normal result. The clinical sign of urine loss was identified in 50 (43.9%) patients. A total of 35 (70%) had SUI on urodynamic study, 6 (12%) had SUI and another diagnosis and 9 (18%) did not have SUI. Urine loss was absent in 64 (56.1%) women. Of those 23 (35.9%) had SUI on urodynamic study, 7 (11%) had SUI and another diagnosis and 34 (53.1%) did not have SUI. Conclusions: clinical history and physical examination are important in the management of urinary incontinence, although they should not be used as the only diagnostic method. Objective tests are available and should be used together with clinical data.

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

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

Views122

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

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

Views34

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

Treatment of Eclampsia: Comparative Study on the Use of Magnesium Sulfate and Phenytoin

Recadastramento de Sócios

Treatment of bacterial vaginosis with Schinus terebinthifolius Raddi vaginal gel: a randomized controlled trial

Grading systems for breast carcinoma: comparative study of cytohistological agreement

Cervical cancer precursor lesions in adolescent and young adult women of Rio Branco – Acre

Tego: Valor Comercial?

Estudo exploratório: ultra-sonografia, ecocardiografia fetal e resultados perinatais em gestantes portadoras do HIV em uso de terapia anti-retroviral

Computerized Antepartum Cardiotocography Analysis in High Risk Pregnancies

Predictive Model using Risk Factors for Cesarean Section

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

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

Correlation Between Laparoscopic Aspects and Histologic Findings in Peritoneal Endometriotic Lesions

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

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

Editorial

Computerized Antepartum Cardiotocography Analysis in High Risk Pregnancies

Predictive Model using Risk Factors for Cesarean Section

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

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

Correlation Between Laparoscopic Aspects and Histologic Findings in Peritoneal Endometriotic Lesions

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

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

Editorial

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