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Editorial
Ética em pesquisa
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):494-494
04-09-1998
Views45This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
EditorialÉtica em pesquisa
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):494-494
04-09-1998This 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. -
Resumos de Teses
Estudo Controlado e Randomizado para Prevenção de Infecção Pós-Cesárea com Penicilina e Cefalotina
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):424-424
04-09-1998
Views40This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Resumos de TesesEstudo Controlado e Randomizado para Prevenção de Infecção Pós-Cesárea com Penicilina e Cefalotina
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):424-424
04-09-1998DOI 10.1590/S0100-72031998000700011
Views40Estudo Controlado e Randomizado para Prevenção de Infecção Pós-Cesárea com Penicilina e Cefalotina […]See moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Resumos de Teses
Estudo Morfológico e Morfométrico do Endométrio de Mulheres na Pós-Menopausa Durante Terapêutica Estrogênica Contínua, Associada ao Acetato de Medroxiprogesterona a Cada Dois, Três e Quatro Meses
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):423-423
04-09-1998
Views35This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Resumos de TesesEstudo Morfológico e Morfométrico do Endométrio de Mulheres na Pós-Menopausa Durante Terapêutica Estrogênica Contínua, Associada ao Acetato de Medroxiprogesterona a Cada Dois, Três e Quatro Meses
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):423-423
04-09-1998DOI 10.1590/S0100-72031998000700009
Views35Estudo Morfológico e Morfométrico do Endométrio de Mulheres na Pós-Menopausa Durante Terapêutica Estrogênica Contínua, Associada ao Acetato de Medroxiprogesterona a Cada Dois, Três e Quatro Meses[…]See moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Resumos de Teses
Sangramento e Endometrite em Pacientes Portadoras de DIU Pós-Placentário na Maternidade de Encruzilhada – Recife (PE)
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):423-424
04-09-1998
Views38This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Resumos de TesesSangramento e Endometrite em Pacientes Portadoras de DIU Pós-Placentário na Maternidade de Encruzilhada – Recife (PE)
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):423-424
04-09-1998DOI 10.1590/S0100-72031998000700010
Views38Sangramento e Endometrite em Pacientes Portadoras de DIU Pós-Placentário na Maternidade de Encruzilhada Recife (PE) […]See moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Relato de Caso
Complete Mole in Twin Pregnancy: a Case Report
- Izildinha Maestá,
- Iracema M.P. Calderon,
- Marilza V.C. Rudge,
- Magaly M. Sales,
- Fabiano P. Saggioro, [ … ],
- José Carlos Peraçoli
04-09-1998
Views72This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Relato de CasoComplete Mole in Twin Pregnancy: a Case Report
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):415-419
04-09-1998DOI 10.1590/S0100-72031998000700008
- Izildinha Maestá,
- Iracema M.P. Calderon,
- Marilza V.C. Rudge,
- Magaly M. Sales,
- Fabiano P. Saggioro,
- José Carlos Peraçoli
Views72Twin pregnancy in which a normal fetus and a complete mole develop at the same time is a rare event. Clinical complications and malignancy are frequent in this type of disease.This report is about a case of a late diagnosis due to the presence of the fetus. The diagnosis was made when the pregnancy was interrupted and then confirmed by histopathological study and flow cytometry. The pregnancy was terminated transpelvically due to massive uterine hemorrhage. The post-molar follow-up showed the persistence of high levels of bhCG. The patient’s complete recovery was achieved after the administration of methotrexate. The diagnosis, natural history, and procedures for this rare disease are discussed in view of this case.
Key-words ChemotherapyComplete hydatidiform moleGestational trophoblastic diseaseHemorrhagePregnancy complicationsTwin pregnancyUltrasonographySee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Relato de Caso
Clear Cell Adenocarcinoma of the Endocervix in a 7-year-old Child
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):411-414
04-09-1998
Views86This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Relato de CasoClear Cell Adenocarcinoma of the Endocervix in a 7-year-old Child
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):411-414
04-09-1998DOI 10.1590/S0100-72031998000700007
Views86See moreClear cell adenocarcinoma of the vagina and cervix is a rare disease associated commonly with the use of diethylstilbestrol (DES) during pregnancy. The most commom complaint is irregular vaginal bleeding, which could be confused with vaginitis in children and abnormalities in the hypothalamic-pituitary axis in adolescents. We report a case of clear cell adenocarcinoma of the endocervix in a 7-year-old child who was attended at the Children and Adolescent Gynecology Sector, and we call attention to the diagnosis of genital cancer which, in spite of its rarity at this age, must be considered in children with genital bleeding.
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. -
Equipamentos e Métodos
Endometrial Resection by Video-Hysteroscopy: experience in a Teaching Hospital
- Caio Parente Barbosa,
- Marcelo Ettruri Santos,
- Ana Cristina Napolitano,
- Paula Harue Tamanaka,
- Emerson Barchi Cordts
04-09-1998
Views78This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Equipamentos e MétodosEndometrial Resection by Video-Hysteroscopy: experience in a Teaching Hospital
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):405-410
04-09-1998DOI 10.1590/S0100-72031998000700006
- Caio Parente Barbosa,
- Marcelo Ettruri Santos,
- Ana Cristina Napolitano,
- Paula Harue Tamanaka,
- Emerson Barchi Cordts
Views78See moreObjective: to demonstrate the effectiveness of video-hysteroscopic endometrial resection in the treatment of abnormal uterine bleeding. Patients and method: The authors studied 60 records of patients with abnormal uterine bleeding who did not respond to clinical treatment. Results: eighty-eight percent of the patients had adequate response to the treatment (53% oligomenorrhea and 35% amenorrhea). The complication rate was 8.3% (5 uterine perforations). Conclusion: video-hysteroscopic endometrial resection is an effective technique to treat abnormal uterine bleeding which failed to respond to clinical management. The intra and postoperative complication rates are low.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Trabalhos Originais
Maternal Mortality in São Paulo City in 1996
- Luis Carlos Pazero,
- Paulo Afonso Ferrigno Marcus,
- Carlos Eduardo Pereira Vega,
- Krikor Boyaciyan,
- Sônia Antonini Barbosa
04-09-1998
Views102This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Trabalhos OriginaisMaternal Mortality in São Paulo City in 1996
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(7):395-403
04-09-1998DOI 10.1590/S0100-72031998000700005
- Luis Carlos Pazero,
- Paulo Afonso Ferrigno Marcus,
- Carlos Eduardo Pereira Vega,
- Krikor Boyaciyan,
- Sônia Antonini Barbosa
Views102Purpose: to establish a list of diseases promoting maternal death according to frequency. Methods: In 1996, 65,406 deaths were recorded in the City of São Paulo, 26,778 of which were of women. Of these, 4591 were within the 10-49 year age bracket. We analyzed the latter group, regarding at the field “Cause of Death” in the Death Certificate, trying to establish some correlation between the described pathology, and the pregnancy-puerperium cycle. We separated for a further study 293 Death Certificates, from which we selected, after hospital survey and/or home visits, a total of 119 positive cases for maternal death. The positive cases for maternal death were then tabulated, grouped and analyzed according to age and pathology, using the great medical care groups. Results: as regards the 119 positive cases for maternal death, we did not find any reference to the pregnancy-puerperium state in 53 of them (that is, 40.54% subnotifying). The cases were grouped according to pathology, where we found a predominance of eclampsia/pre-eclampsia cases (18.02%), followed by cases resulting from hemorrhagic complications in the third quarter and puerperium (12.61%), abortion complications (12.61%), puerperal infection (9.91%) and cardiopathies (9.91%). Conclusions: for the first time, we are publishing the Late Maternal Mortality Coefficient for the City of São Paulo, which was 51.33/100,000 born alive. However, we used for the official publication the Maternal Mortality Coefficient for death within up to 42 days of puerperium, which was, 48.03/100,000 born alive for the city of São Paulo. We should bear in mind that no correction factor should be applied to these figures since we have made an active search of cases.
Key-words Cardiopathy in pregnancyEclampsiaHemorrhagic complications in pregnancyMaternal mortalityMaternal mortality coefficientPregnancy complicationsSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Original Article
Factors associated with the absence of postpartum consultations in a high-risk population
- Ana Carolina Gomes Pereira
,
- Tábata Regina Zumpano dos Santos
,
- Helymar da Costa Machado
,
- Fernanda Garanhani de Castro Surita
04-09-2024
Views371This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleFactors associated with the absence of postpartum consultations in a high-risk population
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo23
04-09-2024- Ana Carolina Gomes Pereira
,
- Tábata Regina Zumpano dos Santos
,
- Helymar da Costa Machado
,
- Fernanda Garanhani de Castro Surita
Views371See moreAbstract
Objective:
To assess the rate of missed postpartum appointments at a referral center for high-risk pregnancy and compare puerperal women who did and did not attend these appointments to identify related factors.
Methods:
This was a retrospective cross-sectional study with all women scheduled for postpartum consultations at a high-risk obstetrics service in 2018. The variables selected to compare women were personal, obstetric, and perinatal. The variables of interest were obtained from the hospital’s electronic medical records. Statistical analyses were performed using the Chi-square, Fisher’s exact, or Mann–Whitney tests. For the variable of the interbirth interval, a receiver operating characteristic curve (ROC) was used to best discriminate whether or not patients attended the postpartum consultation. The significance level for the statistical tests was 5%.
Results:
A total of 1,629 women scheduled for postpartum consultations in 2018 were included. The rate of missing the postpartum consultation was 34.8%. A shorter interbirth interval (p = 0.039), previous use of psychoactive substances (p = 0.027), current or former smoking (p = 0.003), and multiparity (p < 0.001) were associated with non-attendance.
Conclusion:
This study showed a high rate of postpartum appointment non-attendance. This is particularly relevant because it was demonstrated in a high-risk obstetric service linked to clinical severity or social vulnerability cases. This highlights the need for new approaches to puerperal women before hospital discharge and new tools to increase adherence to postpartum consultations, especially for multiparous women.
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. - Ana Carolina Gomes Pereira
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Review Article
Timing of semen cryopreservation: before or after processing?
- Ana Paula de Souza Kussler
,
- Ivan Cunha Bustamante Filho
,
- Elisa Negri
,
- Edison Capp
,
- Helena von Eye Corleta
04-09-2024
Views371This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Review ArticleTiming of semen cryopreservation: before or after processing?
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo36
04-09-2024- Ana Paula de Souza Kussler
,
- Ivan Cunha Bustamante Filho
,
- Elisa Negri
,
- Edison Capp
,
- Helena von Eye Corleta
Views371Abstract
Objective:
Seminal cryopreservation causes significant damage to the sperm; therefore, different methods of cryopreservation have been studied. The aim of the study was to compare the effects of density gradient processing and washing/centrifugation with seminal plasma removal for cryopreservation in semen parameters.
Methods:
Seminal samples of 26 normozoospermic patients were divided into 3 parts: with seminal plasma; after washing/centrifugation; and after selection through density gradient. The samples were cryopreserved for at least two weeks. Motility, sperm count, morphology and viability were evaluated before cryopreservation and after thawing.
Results:
Density gradient processing selected motile and viable sperm with normal morphology in fresh samples (p<0.05). Cryopreservation negatively affected all sperm parameters regardless of the processing performed, and even if the sperm recovery was lower in the density gradient after the thawing, progressive motility, total motility, viability and morphology remained higher (p<0.05).
Conclusion:
Cryopreservation significantly compromises sperm parameters (motility, morphology, viability). In normozoospermic patients, the density gradients select better quality spermatozoa compared to other processing methods; this benefit was kept after thawing.
Key-words CentrifugationCryopreservationDensity gradientSemenSeminal plasmaSperm countSperm washSpermatozoaSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Ana Paula de Souza Kussler
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Original Article
Comparison of medical image interpretation time between conventional and automated methods of breast ultrasound
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo15
00-00-2024
Views366This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleComparison of medical image interpretation time between conventional and automated methods of breast ultrasound
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo15
00-00-2024Views366See moreAbstract
Objective:
To compare the medical image interpretation’s time between the conventional and automated methods of breast ultrasound in patients with breast lesions. Secondarily, to evaluate the agreement between the two methods and interobservers.
Methods:
This is a cross-sectional study with prospective data collection. The agreement’s degrees were established in relation to the breast lesions’s ultrasound descriptors. To determine the accuracy of each method, a biopsy of suspicious lesions was performed, considering the histopathological result as the diagnostic gold standard.
Results:
We evaluated 27 women. Conventional ultrasound used an average medical time of 10.77 minutes (± 2.55) greater than the average of 7.38 minutes (± 2.06) for automated ultrasound (p<0.001). The degrees of agreement between the methods ranged from 0.75 to 0.95 for researcher 1 and from 0.71 to 0.98 for researcher 2. Among the researchers, the degrees of agreement were between 0.63 and 1 for automated ultrasound and between 0.68 and 1 for conventional ultrasound. The area of the ROC curve for the conventional method was 0.67 (p=0.003) for researcher 1 and 0.72 (p<0.001) for researcher 2. The area of the ROC curve for the automated method was 0. 69 (p=0.001) for researcher 1 and 0.78 (p<0.001) for researcher 2.
Conclusion:
We observed less time devoted by the physician to automated ultrasound compared to conventional ultrasound, maintaining accuracy. There was substantial or strong to perfect interobserver agreement and substantial or strong to almost perfect agreement between the methods.
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. -
Letter to the Editor
Letter to Editor: “Combined aerobic and strength training improves dynamic stability and can prevent against static stability decline in postmenopausal women: A randomized clinical trial”
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo26
04-09-2024
Views357This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Letter to the EditorLetter to Editor: “Combined aerobic and strength training improves dynamic stability and can prevent against static stability decline in postmenopausal women: A randomized clinical trial”
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo26
04-09-2024Views357Dear Editor,First and foremost, we express our gratitude towards the authors for their clear and concise description of the positive effects of aerobic and strength training on dynamic stability.() Additionally, their ability to provide a focused and informative introduction section is commendable. The study piqued our interest in further exploring the benefits of aerobic and […]See moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article
Prevalence of colorectal symptoms and anal incontinence in patients with pelvic organ prolapse attended at an outpatient urogynecology service
- Marco Arellano
,
- Fernanda Santis-Moya
,
- Andrea Maluenda
,
- Alejandro Pattillo
,
- Bernardita Blümel
,
[ … ], - Javier Pizarro-Berdichevsky
00-00-2024
Views356This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticlePrevalence of colorectal symptoms and anal incontinence in patients with pelvic organ prolapse attended at an outpatient urogynecology service
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo10
00-00-2024- Marco Arellano
,
- Fernanda Santis-Moya
,
- Andrea Maluenda
,
- Alejandro Pattillo
,
- Bernardita Blümel
,
- Dominga Pohlhammer
,
- Silvana Gonzalez
,
- Javier Pizarro-Berdichevsky
Views356See moreAbstract
Objective:
To analyze data of patients with symptomatic pelvic organ prolapse evaluated with PFDI20 and its subscales to report the prevalence of lower gastrointestinal symptoms and anal incontinence in the population of a public hospital and analyze its impact on quality of life.
Methods:
Cross-sectional study of patients with symptomatic POP. Patients were evaluated with demographic data, POP-Q, pelvic floor ultrasonography, urological parameters, and pelvic floor symptoms (PFDI-20), and quality of life (P-QoL) surveys. Patients were classified as CRADI-8 “positive” for colorectal symptoms, with responses “moderate” in at least 3 and/or “severe” in at least 2 of the items in the CRADI-8 questionnaires.
Results:
One hundred thirteen patients were included. 42.5% (48) were considered positive for colorectal symptoms on CRADI-8. 53.4% presented anal incontinence. No significant differences were found in sociodemographic variables, POP-Q stage, ultrasound parameters, or urological parameters. Positive patients had a significantly worse result in PFDI-20, POPDI (48 vs 28; p<0.001), UDI6 (51 vs 24; p<0.001), and in the areas of social limitation (44.4 vs 22.2; p = 0.045), sleep- energy (61.5 vs 44.4; p = 0.08), and severity (56.8 vs 43.7, p=0.015) according to P-QoL.
Conclusion:
Moderate or severe colorectal symptoms are seen in 40% of patients with symptomatic POP in our unit. Full evaluation of pelvic floor dysfunction symptoms should be performed routinely in urogynecology units.
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. - Marco Arellano
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Original Article
Bacteriological characteristics of primary breast abscesses in patients from the community in the era of microbial resistance
- Vicente Sperb Antonello
,
- Jessica Dallé
,
- Mirela Foresti Jimenez
,
- Patrícia Tramontini
,
- Andrei Gustavo Reginatto
04-09-2024
Views350This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleBacteriological characteristics of primary breast abscesses in patients from the community in the era of microbial resistance
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo34
04-09-2024- Vicente Sperb Antonello
,
- Jessica Dallé
,
- Mirela Foresti Jimenez
,
- Patrícia Tramontini
,
- Andrei Gustavo Reginatto
Views350See moreAbstract
Objective:
The aim of this study is to evaluate the etiological profile and antimicrobial resistance in breast abscess cultures from patients from the community, treated at a public hospital located in Porto Alegre, Brazil.
Methods:
This is an retrospective cross-sectional study that evaluated the medical records of patients with bacterial isolates in breast abscess secretion cultures and their antibiograms, from January 2010 to August 2022.
Results:
Based on 129 positive cultures from women from the community diagnosed with breast abscesses and treated at Fêmina Hospital, 99 (76.7%) of the patients had positive cultures for Staphylococcus sp, 91 (92%) of which were cases of Staphylococcus aureus. Regarding the resistance profile of S. aureus, 32% of the strains were resistant to clindamycin, 26% to oxacillin and 5% to trimethoprim-sulfamethoxazole. The antimicrobials vancomycin, linezolid and tigecycline did not show resistance for S. aureus.
Conclusion:
Staphylococcus aureus was the most common pathogen found in the breast abscess isolates during the study period. Oxacillin remains a good option for hospitalized patients. The use of sulfamethoxazole plus trimethoprim should be considered as a good option for use at home, due to its low bacterial resistance, effectiveness and low cost.
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. - Vicente Sperb Antonello
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Review Article
Efficacy of Transversus Abdominis Plane Block in the Reduction of Pain and Opioid Requirement in Laparoscopic and Robot-assisted Hysterectomy: A Systematic Review and Meta-analysis
- Claudia López-Ruiz
,
- Jerutsa Catalina Orjuela
,
- Diego Fernando Rojas-Gualdrón
,
- Marcela Jimenez-Arango
,
- José Fernando de los Ríos
,
[ … ], - Claudia Vargas
02-28-2022
Views347This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Review ArticleEfficacy of Transversus Abdominis Plane Block in the Reduction of Pain and Opioid Requirement in Laparoscopic and Robot-assisted Hysterectomy: A Systematic Review and Meta-analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(1):55-66
02-28-2022- Claudia López-Ruiz
,
- Jerutsa Catalina Orjuela
,
- Diego Fernando Rojas-Gualdrón
,
- Marcela Jimenez-Arango
,
- José Fernando de los Ríos
,
- Elsa Maria Vásquez-Trespalacios
,
- Claudia Vargas
Views347Abstract
Objective
To summarize the available evidence of TAP Block in efficacy in laparoscopic or robotic hysterectomy.
Data Sources
We searched databases and gray literature for randomized controlled trials in which transversus abdominis plane (TAP) block was compared with placebo or with no treatment in patients who underwent laparoscopic or robot-assisted hysterectomy.
Method of Study
Selection Two researchers independently evaluated the eligibility of the selected articles. Tabulation, Integration, and Results Seven studies were selected, involving 518 patients. Early postoperative pain showed a difference in the mean mean difference (MD): – 1.17 (95% confidence interval [CI]: – 1.87-0.46) in pain scale scores (I2=68%), which was statistically significant in favor of using TAP block, but without clinical relevance; late postoperative pain: DM 0.001 (95%CI: – 0.43-0.44; I2=69%); opioid requirement: DM 0.36 (95%CI: – 0.94-1.68; I2=80%); and incidence of nausea and vomiting with a difference of 95%CI=- 0.11 (- 0.215-0.006) in favor of TAP.
Conclusion
With moderate strength of evidence, due to the high heterogeneity and imbalance in baseline characteristics among studies, the results indicate that TAP block should not be considered as a clinically relevant analgesic technique to improve postoperative pain in laparoscopic or robotic hysterectomy, despite statistical significance in early postoperative pain scale scores.
Key-words laparoscopic hysterectomyOpioidPainrobotic-assisted hysterectomytransversus abdominis plane blockSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Claudia López-Ruiz
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Review Article
Interventions among Pregnant Women in the Field of Music Therapy: A Systematic Review
- Bruna Mayumi Omori Shimada
,
- Magda da Silva Oliveira Menezes dos Santos
,
- Mayara Alvares Cabral
,
- Vanessa Oliveira Silva
,
- Gislaine Cristina Vagetti
07-30-2021
Views346PlumX Metrics- Citations
- Citation Indexes: 21
- Usage
- Full Text Views: 349
- Abstract Views: 40
- Captures
- Readers: 196
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Review ArticleInterventions among Pregnant Women in the Field of Music Therapy: A Systematic Review
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(5):403-413
07-30-2021- Bruna Mayumi Omori Shimada
,
- Magda da Silva Oliveira Menezes dos Santos
,
- Mayara Alvares Cabral
,
- Vanessa Oliveira Silva
,
- Gislaine Cristina Vagetti
Views346See moreAbstract
Objective
To investigate in the literature the studies on the benefits ofmusic therapy interventions among pregnant women in the prenatal, delivery and postpartum periods.
Data Sources
The search for articles was carried out in the following electronic databases: VHL, LILACS, SciELO, Portal CAPES, PsycINFO, ERIC, PubMed/Medline, and journals specialized in this field: Revista Brasileira de Musicoterapia (“Brazilian Journal of Music Therapy”) and Voices.
Study Selection
Descriptors in Portuguese (musicoterapia, gravidez, gestantes, revisão), English (music therapy, pregnancy, pregnant women, review) and Spanish (musicoterapia, embarazo, mujeres embarazadas, revisión) were used. The search was delimited between January 2009 and June 2019. The process of selection and evaluation of the articles was performed through peer review.
Data Collectio
n The following data were extracted: article title, year of publication, journal, author(s), database, country and date of collection, purpose of the study, sample size, type of care, intervention, instruments used, results, and conclusion. The data were organized in chronological order based on the year of publication of thestudy.
Summary of the Data
In total, 146 articles were identified, and only 23 studies were included in this systematic review. The articles found indicate among their results relaxation, decreased levels of anxiety, psychosocial stress and depression, decreased pain, increase in the maternal bond, improvement in the quality of sleep, control of the fetal heart rate and maternal blood pressure, and decreased intake of drugs in the postoperative period.
Conclusion
Music therapy during the prenatal, delivery and postpartum periods can provide benefits to pregnant women and newborns, thus justifying its importance in this field.
PlumX Metrics- Citations
- Citation Indexes: 21
- Usage
- Full Text Views: 349
- Abstract Views: 40
- Captures
- Readers: 196
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. - Bruna Mayumi Omori Shimada
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Review Article
Efficacy of Hormonal and Nonhormonal Approaches to Vaginal Atrophy and Sexual Dysfunctions in Postmenopausal Women: A Systematic Review
- Ayane Cristine Alves Sarmento
,
- Ana Paula Ferreira Costa
,
- Juliana Lírio
,
- José Eleutério Jr
,
- Pedro Vieira Baptista
,
[ … ], - Ana Katherine Gonçalves
01-23-2022
Views299This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Review ArticleEfficacy of Hormonal and Nonhormonal Approaches to Vaginal Atrophy and Sexual Dysfunctions in Postmenopausal Women: A Systematic Review
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(10):986-994
01-23-2022- Ayane Cristine Alves Sarmento
,
- Ana Paula Ferreira Costa
,
- Juliana Lírio
,
- José Eleutério Jr
,
- Pedro Vieira Baptista
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- Ana Katherine Gonçalves
Views299See moreAbstract
Objective
To evaluate the efficacy of the hormonal and nonhormonal approaches to symptoms of sexual dysfunction and vaginal atrophy in postmenopausal women.
Data Sources
We conducted a search on the PubMed, Embase, Scopus, Web of Science, SciELO, the Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, as well as on clinical trial databases. We analyzed studies published between 1996 and May 30, 2020. No language restrictions were applied.
Selection of Studies
We selected randomized clinical trials that evaluated the treatment of sexual dysfunction in postmenopausal women.
Data Collection
Three authors (ACAS, APFC, and JL) reviewed each article based on its title and abstract. Relevant data were subsequently taken from the full-text article. Any discrepancies during the review were resolved by consensus between all the listed authors.
Data Synthesis
A total of 55 studies were included in the systematic review. The approaches tested to treat sexual dysfunction were as follows: lubricants and moisturizers (18 studies); phytoestrogens (14 studies); dehydroepiandrosterone (DHEA; 8 studies); ospemifene (5 studies); vaginal testosterone (4 studies); pelvic floor muscle exercises (2 studies); oxytocin (2 studies); vaginal CO2 laser (2 studies); lidocaine (1 study); and vitamin E vaginal suppository (1 study).
Conclusion
We identified literature that lacks coherence in terms of the proposed treatments and selected outcome measures. Despite the great diversity in treatment modalities and outcome measures, the present systematic review can shed light on potential targets for the treatment, which is deemed necessary for sexual dysfunction, assuming that most randomized trials were evaluated with a low risk of bias according to the Cochrane Collaboration risk of bias tool. The present review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018100488).
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. - Ayane Cristine Alves Sarmento
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Review Article
Placental Findings in Preterm and Term Preeclampsia: An Integrative Review of the Literature
- Luciana Pietro
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- José Paulo de Siqueira Guida
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- Guilherme de Moraes Nobrega
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- Arthur Antolini-Tavares
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- Maria Laura Costa
10-18-2021
Views212This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Review ArticlePlacental Findings in Preterm and Term Preeclampsia: An Integrative Review of the Literature
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(7):560-569
10-18-2021- Luciana Pietro
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- José Paulo de Siqueira Guida
,
- Guilherme de Moraes Nobrega
,
- Arthur Antolini-Tavares
,
- Maria Laura Costa
Views212Abstract
Introduction
Preeclampsia (PE) is a pregnancy complication associated with increased maternal and perinatal morbidity and mortality. The disease presents with recent onset hypertension (after 20 weeks of gestation) and proteinuria, and can progress to multiple organ dysfunction, with worse outcomes among early onset preeclampsia (EOP) cases (<34 weeks). The placenta is considered the root cause of PE; it represents the interface between the mother and the fetus, and acts as a macromembrane between the two circulations, due to its villous and vascular structures. Therefore, in pathological conditions, macroscopic and microscopic evaluation can provide clinically useful information that can confirm diagnosis and enlighten about outcomes and future therapeutic benefit.
Objective
To perform an integrative review of the literature on pathological placental findings associated to preeclampsia (comparing EOP and late onset preeclampsia [LOP]) and its impacts on clinical manifestations.
Results:
Cases of EOP presented worse maternal and perinatal outcomes, and pathophysiological and anatomopathological findings were different between EOP and LOP placentas, with less placental perfusion, greater placental pathological changes with less villous volume (villous hypoplasia), greater amount of trophoblastic debris, syncytial nodules, microcalcification, villous infarcts, decidual arteriolopathy in EOP placentas when compared with LOP placentas. Clinically, the use of low doses of aspirin has been shown to be effective in preventing PE, as well asmagnesium sulfate in preventing seizures in cases of severe features.
Conclusion
The anatomopathological characteristics between EOP and LOP are significantly different, with large morphological changes in cases of EOP, such as
Key-words anatomopathological characteristicsmaternal mortality and morbidityPlacentapreeclampsia early onsetpreeclampsia late onsetSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Luciana Pietro
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Review Article
Management Strategies for Sexuality Complaints after Gynecologic Cancer: A Systematic Review
- Luciane Machado Pizetta
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- Augusto da Cunha Reis
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- Mirian Picinini Méxas
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- Vanessa de Almeida Guimarães
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- Carmen Lucia de Paula
09-29-2022
Views148This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Review ArticleManagement Strategies for Sexuality Complaints after Gynecologic Cancer: A Systematic Review
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(10):962-971
09-29-2022- Luciane Machado Pizetta
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- Augusto da Cunha Reis
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- Mirian Picinini Méxas
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- Vanessa de Almeida Guimarães
,
- Carmen Lucia de Paula
Views148See moreAbstract
Objective
To explore the main sexuality complaints of gynecologic cancer survivors after treatment and to identify the care strategies provided.
Data Source
Searches were conducted in six electronic databases: Scopus, Web of Science, LILACS, MEDLINE, PsychINFO, and EMBASE.
Study Selection
Articles published between 2010 and 2020 were selected and the following descriptors were used in the English language: female genital neoplasms and gynaecological cancer. The methodological quality of the studies used the Mixed Methods Appraisal Tool (MMAT).
Data Collection
The primary data extracted were: names of the authors, year of publication, country of origin, objective and type of study, data collection instrument, sample size and age range, types of cancer, and symptoms affected with the strategies adopted.
Data Summary
A total of 34 out of 2,536 screened articles were included. The main strategies found for patient care were patient-clinician communication, practices for sexuality care, individualized care plan, multiprofessional team support, and development of rehabilitation programs. For sexuality care, the most common practices are pelvic physiotherapy sessions and the use of vaginal gels and moisturizers.
Conclusion
The main complaints identified in the scientific literature were low libido and lack of interest in sexual activity, vaginal dryness, pain during sexual intercourse, and stenosis. Different care strategies may be adopted, such as follow-up with a multidisciplinary health team and sexual health rehabilitation programs, which could minimize these symptoms and ensure the quality of life of patients.
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. - Luciane Machado Pizetta
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Review Article
Non-pharmacological Interventions for Improving Sleep Quality During Pregnancy: A Systematic Review and Meta-Analysis
- Daiane Sofia Morais Paulino
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- Carolina Bicudo Borrelli
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- Débora Bicudo Faria-Schützer
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- Luiz Gustavo Oliveira Brito
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- Fernanda Garanhani Surita
05-23-2022
Views215This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Review ArticleNon-pharmacological Interventions for Improving Sleep Quality During Pregnancy: A Systematic Review and Meta-Analysis
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(8):776-784
05-23-2022- Daiane Sofia Morais Paulino
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- Carolina Bicudo Borrelli
,
- Débora Bicudo Faria-Schützer
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- Luiz Gustavo Oliveira Brito
,
- Fernanda Garanhani Surita
Views215Abstract
Objective
To investigate the effect of non-pharmacological interventions to improve sleep quality during pregnancy.
Data sources
A search was made in the NCBI/PubMed, ClinicalTrials.gov, Embase, BVS, and Web of Science databases. There were no limitations regarding language, sample size, and type of non-pharmacological intervention. We have included prospective clinical trials between July 2014 and July 2019.
Selection of studies
This study was registered in the Prospective International Registration of Systematic Reviews (PROSPERO) database was performed. Publication bias was also assessed with funnel plots. the primary outcome was the total score in the Pittsburgh Sleep Quality Index (PSQI) before and after intervention. Risk of bias and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria were used for assessing methodological quality. From the 28 retrieved studies, we have selected 8 for qualitative analysis and 6 for meta-analysis.
Data collection
Two independent reviewers performed the study selection. In the case of disagreement, a third senior reviewer was consulted. The study was initially assessed based on the title, followed by abstract. Lastly, the full text was assessed to be included.
Data Synthesis
A significant improvement on the sleep quality (PSQI score) was observed when all interventions were grouped (MD = -3.03, 95%CI -4.15 to -1.92, n= 623, i2= 84%, p< 0.001). Analysis by subgroup (music listening: MD = -1.96, 95% CI -3.27 to -0.65, n= 207, i2= 67%, p= 0.003 and other interventions: MD = -3.66, 95% CI -4.93 to -2.40, n= 416, i2 = 80%, p< 0.001) showed an improvement, with high heterogeneity. Risk of bias has shown performance and detection bias for almost studies, and GRADE evidence was very low for all analyzed variables.
Conclusion
Non-pharmacological interventions—listening to music, physical exercise, relaxation exercises, lettuce seed, sleep hygiene, and acupressure—are effective for improving sleep quality during pregnancy.
Key-words Meta-analysisnon-pharmacological interventionsPregnant womensleep qualitysystematic reviewSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Daiane Sofia Morais Paulino
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Case Report
Uterine Rescue in High-Risk Gestational Trophoblastic Neoplasia Treated with EMA-CO by Uterine Arteries Embolization due to Arteriovenous Malformations
- Arlley Cleverson Belo da Silva
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- Jurandir Piassi Passos
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- Roney Cesar Signorini Filho
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- Antonio Braga
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- Rosiane Mattar
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[ … ], - Sue Yazaki Sun
06-18-2021
Views175This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Case ReportUterine Rescue in High-Risk Gestational Trophoblastic Neoplasia Treated with EMA-CO by Uterine Arteries Embolization due to Arteriovenous Malformations
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(4):323-328
06-18-2021- Arlley Cleverson Belo da Silva
,
- Jurandir Piassi Passos
,
- Roney Cesar Signorini Filho
,
- Antonio Braga
,
- Rosiane Mattar
,
- Sue Yazaki Sun
Views175Abstract
Complete hydatidiform mole (CHM) is a rare type of pregnancy, in which 15 to 20% of the cases may develop into gestational trophoblastic neoplasia (GTN). The diagnostic of GTN must be done as early as possible through weekly surveillance of serum hCG after uterine evacuation.We report the case of 23-year-old primigravida, with CHM but without surveillance of hCG after uterine evacuation. Two months later, the patient presented to the emergency with vaginal bleeding and was referred to the Centro de Doenças Trofoblásticas do Hospital São Paulo. She was diagnosed with high risk GTN stage/score III:7 as per The International Federation of Gynecology and Obstetrics/World Health Organization (FIGO/WHO). The sonographic examination revealed enlarged uterus with a heterogeneous mass constituted of multiple large vessels invading and causing disarrangement of the myometrium. The patient evolved with progressive worsening of vaginal bleeding after chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) regimen. She underwent blood transfusion and embolization of uterine arteries due to severe vaginal hemorrhage episodes, with complete control of bleeding. The hCG reached a negative value after the third cycle, and there was a complete regression of the anomalous vascularization of the uterus as well as full recovery of the uterine anatomy. The treatment in a reference center was essential for the appropriate management, especially regarding the uterine arteries embolization trough percutaneous femoral
Key-words EMA-CO protocolGestational trophoblastic diseaseGestational trophoblastic neoplasiaHigh risk pregnancyUterine artery embolizationSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Arlley Cleverson Belo da Silva
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FEBRASGO POSITION STATEMENT
Abnormal uterine bleeding and chronic iron deficiency: Number 11 – December 2022
- Venina Viana de Barros
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- Eliane Azeka Hase
,
- Cristiano Caetano Salazar
,
- Ana Maria Kondo Igai
,
- Fernanda Andrade Orsi
,
[ … ], - Paulo Francisco Ramos Margarido
03-24-2022
Views204This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
FEBRASGO POSITION STATEMENTAbnormal uterine bleeding and chronic iron deficiency: Number 11 – December 2022
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(12):1161-1168
03-24-2022This 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. - Venina Viana de Barros
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Original Article
Increment of Maternal Mortality Among Admissions for Childbirth in Low-risk Pregnant Women in Brazil: Effect of COVID-19 Pandemic?
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(8):740-745
07-07-2022
Views143This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleIncrement of Maternal Mortality Among Admissions for Childbirth in Low-risk Pregnant Women in Brazil: Effect of COVID-19 Pandemic?
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(8):740-745
07-07-2022Views143See moreAbstract
Objective
To assess the possible impact of the COVID-19 pandemic on maternal mortality among admissions for childbirth in 2020 in relation of the last 10 years.
Methods
An ecological study with pregnant women who underwent hospital births at the Brazilian unified public health service (SUS, in the Portuguese acronym) in Brazil from 2010 to 2020. The mortality among admissions for childbirth was obtained based on the number of admissions for childbirth with reported death as outcome divided by the total number of admissions. The underlying gestational risk and route of delivery were considered based on the national surveillance system. The average mortality for the period between 2010 and 2019 (baseline) was compared with the rate of deaths in 2020 (1st pandemic year); the rate ratio was interpreted as the risk of death in 2020 in relation to the average of the previous period (RR), with 95% confidence intervals (CIs).
Results
In 2020, the 1st year of the COVID-19 pandemic, 1,821,775 pregnant women were hospitalized for childbirth and 651 deaths were reported, which represents 8.7% of the total hospitalizations and 11.3% of maternal deaths between 2010 and 2020. There was an increase in maternal mortality after births in 2020 compared with the average for the period between 2010 and 2019, specially in low-risk pregnancies, both in vaginal (RR = 1.60; 95%CI:1.39–1.85) and cesarean births (RR = 1.18; 95%CI:1.04–1.34).
Conclusion
Maternal mortality among admissions for childbirth according to SUS data increased in 2020 compared with the average between 2010 and 2019, with an increment of 40% in low-risk pregnancies. The increase was of 18% after cesarean section and of 60% after vaginal delivery.
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. -
Review Article
Clinical Features and Maternal-fetal Results of Pregnant Women in COVID-19 Times
- Ana Paula Nogueira Godoi
,
- Gilcelia Correia Santos Bernardes
,
- Leilismara Sousa Nogueira
,
- Patrícia Nessralla Alpoim
,
- Melina de Barros Pinheiro
07-30-2021
Views237This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Review ArticleClinical Features and Maternal-fetal Results of Pregnant Women in COVID-19 Times
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(5):384-394
07-30-2021- Ana Paula Nogueira Godoi
,
- Gilcelia Correia Santos Bernardes
,
- Leilismara Sousa Nogueira
,
- Patrícia Nessralla Alpoim
,
- Melina de Barros Pinheiro
Views237See moreAbstract
Objective
Coronavirus disease 2019 (COVID-19) is a disease caused by a newly discovered coronavirus, severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), which usually leads to non-specific respiratory symptoms. Although pregnant women are considered at risk for respiratory infections by other viruses, such as SARS and Middle East respiratory syndrome (MERS), little is known about their vulnerability to SARS-CoV-2. Therefore, this study aims to identify and present the main studies on the topic, including the postpartum period.
Methods
In this narrative review, articles were searched in various databases, organizations, and health entities using keywords compatible with medical subject headings (MeSH), such as: COVID-19, pregnancy, vertical transmission, coronavirus 2019, and SARS-CoV-2.
Results
The review of the scientific literature on the subject revealed that pregnant women with COVID-19 did not present clinical manifestations significantly different from those of non-pregnant women; however, there are contraindicated therapies. Regarding fetuses, studies were identified that reported that infection by SARS-CoV-2 in pregnant women can cause fetal distress, breathing difficulties and premature birth, but there is no substantial evidence of vertical transmission.
Conclusion
Due to the lack of adequate information and the limitations of the analyzed studies, it is necessary to provide detailed clinical data on pregnant women infected with SARS-CoV-2 and on the maternal-fetal repercussions caused by this infection. Thus, this review may contribute to expand the knowledge of professionals working in the area as well as to guide more advanced studies on the risk related to pregnant women and their newborns. Meanwhile, monitoring of confirmed or suspected pregnant women with COVID-19 is essential, including in the postpartum period.
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. - Ana Paula Nogueira Godoi
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